Provider Demographics
NPI:1669245270
Name:JOHNSON, JULIA (MS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EASTERN PKWY # 1
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3817
Mailing Address - Country:US
Mailing Address - Phone:973-789-1679
Mailing Address - Fax:
Practice Address - Street 1:210 EASTERN PKWY # 1
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3817
Practice Address - Country:US
Practice Address - Phone:973-789-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst