Provider Demographics
NPI:1801020813
Name:JOHNSON, KEISHA A (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 RAVINE AVENUE
Mailing Address - Street 2:APT. VB5E
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-376-5124
Mailing Address - Fax:914-457-2386
Practice Address - Street 1:135 LOCUST HILL AVENUE
Practice Address - Street 2:MARTIN LUTHER KING ELEMENTARY SCHOOL C/O WJCS
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-376-5124
Practice Address - Fax:914-457-2386
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068506-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker