Provider Demographics
NPI:1407726482
Name:JOHNSON, YVETTE MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W STATE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2332
Mailing Address - Country:US
Mailing Address - Phone:607-723-7308
Mailing Address - Fax:
Practice Address - Street 1:30 W STATE ST FL 2
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2307
Practice Address - Country:US
Practice Address - Phone:607-723-7308
Practice Address - Fax:607-724-4626
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0933201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty