Provider Demographics
NPI:1952882110
Name:JOHNSON, REBECCA ANDRA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANDRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANDRA
Other - Last Name:PENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW; LICSW
Mailing Address - Street 1:1 ADMINISTRATION RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3230
Mailing Address - Country:US
Mailing Address - Phone:508-279-6094
Mailing Address - Fax:
Practice Address - Street 1:1 ADMINISTRATION RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3230
Practice Address - Country:US
Practice Address - Phone:508-279-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1203261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical