Provider Demographics
NPI:1023431723
Name:JOHNSON, ELIZABETH ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
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 1:625 N MAPLE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1589
Mailing Address - Country:US
Mailing Address - Phone:201-241-2422
Mailing Address - Fax:
Practice Address - Street 1:625 N MAPLE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1589
Practice Address - Country:US
Practice Address - Phone:201-241-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL061670001041C0700X
1041C0700X
NJ44SC058095001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical