Provider Demographics
NPI:1285981050
Name:JOHNSON, DANYELL
Entity type:Individual
Prefix:
First Name:DANYELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRWAY DR STE 140V
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1812
Mailing Address - Country:US
Mailing Address - Phone:561-921-7149
Mailing Address - Fax:561-530-2039
Practice Address - Street 1:10 FAIRWAY DR STE 140V
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1812
Practice Address - Country:US
Practice Address - Phone:561-921-7149
Practice Address - Fax:561-530-2039
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW130611041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457868812OtherNPI ORGANIZATION NUMBER
FL015563600Medicaid