Provider Demographics
NPI:1811732597
Name:JOHNSON, TANIA (LMHC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2422
Mailing Address - Country:US
Mailing Address - Phone:917-946-8268
Mailing Address - Fax:
Practice Address - Street 1:20 S BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3713
Practice Address - Country:US
Practice Address - Phone:914-964-6767
Practice Address - Fax:914-964-8282
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP123174101YM0800X
NY016042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health