Provider Demographics
NPI:1750496188
Name:CZAMANSKI, JOHANNA (ATR-BC LPC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:CZAMANSKI
Suffix:
Gender:F
Credentials:ATR-BC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 E COPPER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3214
Mailing Address - Country:US
Mailing Address - Phone:520-205-7549
Mailing Address - Fax:
Practice Address - Street 1:1802 W. ST. MARY'S RD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-205-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11917OtherSTATE LICENSE NUMBER