Provider Demographics
NPI:1952178527
Name:JOHNSON, SHAWN P
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:P
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 1:316 STATION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1833
Mailing Address - Country:US
Mailing Address - Phone:412-221-1091
Mailing Address - Fax:
Practice Address - Street 1:373 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1623
Practice Address - Country:US
Practice Address - Phone:724-387-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)