1477715951 NPI number — MS. DAVA NAOMI JOHNSON MS NCC LPC

Table of content: MS. DAVA NAOMI JOHNSON MS NCC LPC (NPI 1477715951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477715951 NPI number — MS. DAVA NAOMI JOHNSON MS NCC LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DAVA
Provider Middle Name:
NAOMI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS NCC LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWENTHAL
Provider Other First Name:
DAVA
Provider Other Middle Name:
NAOMI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477715951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 GERMANTOWN ROAD
Provider Second Line Business Mailing Address:
BEHAVIORAL MEDICINE AND COUNSELING CENTER
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-748-1200
Provider Business Mailing Address Fax Number:
203-790-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 GERMANTOWN ROAD
Provider Second Line Business Practice Location Address:
BEHAVIORAL MEDICINE AND COUNSELING CENTER
Provider Business Practice Location Address City Name:
DANBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-748-1200
Provider Business Practice Location Address Fax Number:
203-790-0010
Provider Enumeration Date:
06/26/2008

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: 101YP2500X , with the licence number:  001483 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 240001483CT01 . This is a "ANTHEM BLUE CROSS BLUE SHIELD ANTHEM BEHAVIORAL HEALTH NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7967874 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".