Provider Demographics
NPI:1356621692
Name:JOHNSON, PATRICE ANITA (MSW, RSW)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:ANITA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2959
Mailing Address - Country:US
Mailing Address - Phone:504-482-2735
Mailing Address - Fax:
Practice Address - Street 1:2314 DANTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-2959
Practice Address - Country:US
Practice Address - Phone:504-482-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9250104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker