Provider Demographics
NPI:1013354026
Name:MARIA JOHNSON
Entity Type:Organization
Organization Name:MARIA JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-451-1258
Mailing Address - Street 1:671 BAUER CT
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4312
Mailing Address - Country:US
Mailing Address - Phone:516-451-1258
Mailing Address - Fax:516-285-1616
Practice Address - Street 1:430 W MERRICK RD
Practice Address - Street 2:SUITE 25
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5201
Practice Address - Country:US
Practice Address - Phone:516-451-1258
Practice Address - Fax:516-285-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8118596OtherSTATE OF NEW YORK REGISTRATION CERTIFICATE