Provider Demographics
NPI:1881135358
Name:JOHNSON, ANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
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 1:20 WATERHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1268
Mailing Address - Country:US
Mailing Address - Phone:860-964-3667
Mailing Address - Fax:
Practice Address - Street 1:158 WESTBROOK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1553
Practice Address - Country:US
Practice Address - Phone:860-575-1671
Practice Address - Fax:866-706-1701
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical