Provider Demographics
NPI:1295945947
Name:JOHNSON, HOLLY HARRISON
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HARRISON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:HARRISON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOANALYST,LCSW
Mailing Address - Street 1:96 DENOW RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2047
Mailing Address - Country:US
Mailing Address - Phone:609-896-0099
Mailing Address - Fax:
Practice Address - Street 1:96 DENOW RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2047
Practice Address - Country:US
Practice Address - Phone:609-896-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000493102L00000X
NY0728101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical