Provider Demographics
NPI:1023459716
Name:JOHNSON, CAMELLIA A (LCSW,MSW,BA)
Entity type:Individual
Prefix:
First Name:CAMELLIA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW,MSW,BA
Other - Prefix:
Other - First Name:CAMELLIA
Other - Middle Name:A
Other - Last Name:REDWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,MSW,BA
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:TORRINGTON CLINICAL SERVICES BLDG 2 SUITE 2203
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-626-7007
Practice Address - Fax:860-626-7014
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT93361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherOPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT13671479OtherCAQH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTTORRINGTON D339230OtherBEACON HEALTH
CT008064941Medicaid
CT060669107OtherUBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTPENDINGOtherMHN TRICARENORTH
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY