Provider Demographics
NPI:1881893063
Name:JOHNSON, NANCY FLEISHER
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:FLEISHER
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 1:2517 HIGHWAY 35
Mailing Address - Street 2:BLDG. J, SUITE 103
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1918
Mailing Address - Country:US
Mailing Address - Phone:732-996-0808
Mailing Address - Fax:
Practice Address - Street 1:2517 HIGHWAY 35
Practice Address - Street 2:BLDG. J, SUITE 103
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1918
Practice Address - Country:US
Practice Address - Phone:732-996-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical