Provider Demographics
NPI:1700870409
Name:JOHNSON, PETER ALPHONSUS (MSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ALPHONSUS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41 BOX 3964
Mailing Address - Street 2:
Mailing Address - City:APO AE
Mailing Address - State:EAST ANGLIA
Mailing Address - Zip Code:09464
Mailing Address - Country:GB
Mailing Address - Phone:0163-852-8070
Mailing Address - Fax:0163-852-8649
Practice Address - Street 1:UNIT 5210 BOX 230
Practice Address - Street 2:
Practice Address - City:APO AE
Practice Address - State:EAST ANGLIA
Practice Address - Zip Code:09461-0230
Practice Address - Country:GB
Practice Address - Phone:0163-852-8070
Practice Address - Fax:0163-852-8649
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010742901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical