Provider Demographics
NPI:1578917886
Name:JOHNSON, ALICE (LICSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WATER ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3032
Mailing Address - Country:US
Mailing Address - Phone:781-246-2003
Mailing Address - Fax:
Practice Address - Street 1:27 WATER ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3032
Practice Address - Country:US
Practice Address - Phone:781-246-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical