Provider Demographics
NPI:1972066017
Name:JOHNSON, JEANNI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANNI
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JEANNI
Other - Middle Name:LYNN
Other - Last Name:JOHNSON-GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 HARBOR SQ APT 524
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4530
Mailing Address - Country:US
Mailing Address - Phone:845-709-4770
Mailing Address - Fax:
Practice Address - Street 1:1 HARBOR SQ APT 524
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4530
Practice Address - Country:US
Practice Address - Phone:845-709-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0836531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical