Provider Demographics
NPI:1881819696
Name:JOHNSON, JAYNE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BAY BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2924
Mailing Address - Country:US
Mailing Address - Phone:727-596-4344
Mailing Address - Fax:
Practice Address - Street 1:6440 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8402
Practice Address - Country:US
Practice Address - Phone:727-341-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7415174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist