Provider Demographics
NPI:1366885808
Name:JOHNSTON, CAROLINE MCKINLEY (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MCKINLEY
Last Name:JOHNSTON
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 1:39 N 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2144
Mailing Address - Country:US
Mailing Address - Phone:570-664-6658
Mailing Address - Fax:
Practice Address - Street 1:39 N 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2144
Practice Address - Country:US
Practice Address - Phone:570-664-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0191481041C0700X
NY083778-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical