Provider Demographics
NPI:1821512260
Name:JOHNSON, MARIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIELLE
Other - Middle Name:
Other - Last Name:DADDONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:375 MATHER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3101
Mailing Address - Country:US
Mailing Address - Phone:203-601-2775
Mailing Address - Fax:
Practice Address - Street 1:375 MATHER ST STE 1
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3101
Practice Address - Country:US
Practice Address - Phone:203-601-2775
Practice Address - Fax:203-601-2775
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker