Provider Demographics
NPI:1255119921
Name:JOHNSON, MICHAEL MAURICE (PEER SPECIALIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAURICE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 LOCUST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4573
Mailing Address - Country:US
Mailing Address - Phone:716-370-4666
Mailing Address - Fax:716-201-1655
Practice Address - Street 1:3830 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4212
Practice Address - Country:US
Practice Address - Phone:716-895-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator