Provider Demographics
NPI:1760555437
Name:JOHNSON, MARK CARROLL SR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CARROLL
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:LMFT
Other - Prefix:
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Mailing Address - Street 1:187 ASPETUCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-5613
Mailing Address - Country:US
Mailing Address - Phone:860-354-4992
Mailing Address - Fax:860-354-4238
Practice Address - Street 1:35 PARK LANE RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2916
Practice Address - Country:US
Practice Address - Phone:860-354-4135
Practice Address - Fax:860-354-4238
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health