Provider Demographics
NPI:1952715468
Name:SUTHERLAND-JOHNSON, ANDITO D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDITO
Middle Name:D
Last Name:SUTHERLAND-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 1:211 E 43RD STREET
Mailing Address - Street 2:7TH FLOOR #357
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:917-877-0295
Mailing Address - Fax:
Practice Address - Street 1:11 E 109TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3457
Practice Address - Country:US
Practice Address - Phone:917-877-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091975-1104100000X
LA178271041C0700X
NY0939141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker