Provider Demographics
NPI:1831454578
Name:JOHNSON, JESSICA LEIGH
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 HALSTEAD AVE
Mailing Address - Street 2:APARTMENT 4A
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-3838
Mailing Address - Country:US
Mailing Address - Phone:914-497-6424
Mailing Address - Fax:
Practice Address - Street 1:1890 PALMER AVE STE 404
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3031
Practice Address - Country:US
Practice Address - Phone:914-833-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY834375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst