1437369121 NPI number — KAREN SONG JOHNSON-CROMWELL PCC-S, LPC

Table of content: KAREN SONG JOHNSON-CROMWELL PCC-S, LPC (NPI 1437369121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437369121 NPI number — KAREN SONG JOHNSON-CROMWELL PCC-S, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON-CROMWELL
Provider First Name:
KAREN
Provider Middle Name:
SONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCC-S, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROMWELL
Provider Other First Name:
KAREN
Provider Other Middle Name:
SONG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PCC-S
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437369121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 LANSING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANTUA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08051-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-348-8485
Provider Business Mailing Address Fax Number:
866-629-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 COOPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-4667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-348-8485
Provider Business Practice Location Address Fax Number:
866-629-1075
Provider Enumeration Date:
05/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  37PC00561900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: E0007154 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)