Most Relevant Information
Provider Data
| NPI Number: | 1003177577 |
| Provider Name: | JACQUELINE JOHNSON LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 078459 |
Most Important Dates
| Enumeration Date: | 05/31/2012 |
| Last Updated: | 05/31/2012 |
Provider Practice Location
633 GIDNEY AVE
SUITE 6
NEWBURGH
NY
125502800
Practice Location Phone/Fax
| Phone: | 8455692900 |
| Fax: | 8666195710 |
Provider Mailing Location
633 GIDNEY AVE
SUITE 6
NEWBURGH
NY
125502800
Provider Mailing Phone/Fax
| Phone: | 8455692900 |
| Fax: | 8666195710 |