Provider Demographics
NPI:1790550168
Name:JOHNSON, JOSEPH STANLEY JR
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STANLEY
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 TRESSER BLVD APT 15H
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3423
Mailing Address - Country:US
Mailing Address - Phone:203-536-5330
Mailing Address - Fax:
Practice Address - Street 1:133 TRESSER BLVD APT 15H
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3423
Practice Address - Country:US
Practice Address - Phone:203-536-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116011101YM0800X
CT004199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health