Provider Demographics
NPI:1134550593
Name:JOHNSON, JAMES MATTHEW (LCSW-R)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 20TH ST STE 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1310
Mailing Address - Country:US
Mailing Address - Phone:347-247-6624
Mailing Address - Fax:
Practice Address - Street 1:30 E 20TH ST STE 5F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1310
Practice Address - Country:US
Practice Address - Phone:347-247-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0862541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical