Provider Demographics
NPI:1629198346
Name:JOHNSON, DONNA LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
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 1:4205 SUGAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1103
Mailing Address - Country:US
Mailing Address - Phone:561-997-5372
Mailing Address - Fax:561-241-3018
Practice Address - Street 1:4205 SUGAR PINE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1103
Practice Address - Country:US
Practice Address - Phone:561-997-5372
Practice Address - Fax:561-241-3018
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL.C.S.W.OtherLICENCED CLINICAL SOCIAL