Provider Demographics
NPI:1871311191
Name:DURAZZI, JOHANNA ROSE (LSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ROSE
Last Name:DURAZZI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6679
Mailing Address - Country:US
Mailing Address - Phone:609-513-4058
Mailing Address - Fax:
Practice Address - Street 1:444 COVENTRY WAY
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-6679
Practice Address - Country:US
Practice Address - Phone:609-513-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07121300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker