Provider Demographics
NPI:1649572173
Name:JOHNSON, ALBERT L JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:L
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26B MORTSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1316
Mailing Address - Country:US
Mailing Address - Phone:860-560-0035
Mailing Address - Fax:860-560-0035
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1860
Practice Address - Country:US
Practice Address - Phone:860-478-1207
Practice Address - Fax:860-838-6458
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical