Provider Demographics
NPI:1568989226
Name:JOHNSON, SHANTEL SHERYL (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:SHANTEL
Middle Name:SHERYL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1720
Mailing Address - Country:US
Mailing Address - Phone:917-903-8526
Mailing Address - Fax:
Practice Address - Street 1:6603 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1433
Practice Address - Country:US
Practice Address - Phone:718-471-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker