Provider Demographics
NPI:1851678254
Name:JOHNSON, LINDA KAY (BSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2828
Mailing Address - Country:US
Mailing Address - Phone:321-262-1144
Mailing Address - Fax:407-688-0055
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUTIE 106
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-688-0088
Practice Address - Fax:407-688-0055
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker