Provider Demographics
NPI:1639357932
Name:JOHNSON, RAE LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RAE
Middle Name:LYNN
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 1:1920 S OCEAN DR
Mailing Address - Street 2:UNIT 1202
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3764
Mailing Address - Country:US
Mailing Address - Phone:954-593-3564
Mailing Address - Fax:954-587-0040
Practice Address - Street 1:1920 S OCEAN DR
Practice Address - Street 2:UNIT 1202
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3764
Practice Address - Country:US
Practice Address - Phone:954-593-3564
Practice Address - Fax:954-587-0040
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW42971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical