Provider Demographics
NPI:1255211223
Name:JOHNSON, DINA Y (MFT-LP)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:Y
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LIANNE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5337
Mailing Address - Country:US
Mailing Address - Phone:585-489-4833
Mailing Address - Fax:
Practice Address - Street 1:21 LIANNE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5337
Practice Address - Country:US
Practice Address - Phone:585-489-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-P125222-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health