Provider Demographics
NPI:1871738179
Name:JOHNSON, KAY M (LICSW, LCSW-R)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4403
Mailing Address - Country:US
Mailing Address - Phone:917-589-6283
Mailing Address - Fax:
Practice Address - Street 1:333 E 92ND ST
Practice Address - Street 2:#5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5466
Practice Address - Country:US
Practice Address - Phone:917-589-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036125-11041C0700X
MA1122531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical