Provider Demographics
NPI:1598532400
Name:JOHNSON, DANA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MORRILL ST
Mailing Address - Street 2:
Mailing Address - City:BUCKFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-4221
Mailing Address - Country:US
Mailing Address - Phone:207-408-1733
Mailing Address - Fax:
Practice Address - Street 1:66 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5227
Practice Address - Country:US
Practice Address - Phone:207-873-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC205401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical