Provider Demographics
NPI:1942194626
Name:JOHNSON, NICHOLE (LMSW)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 202ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3420
Mailing Address - Country:US
Mailing Address - Phone:917-683-6226
Mailing Address - Fax:917-683-6226
Practice Address - Street 1:10031 202ND ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-3420
Practice Address - Country:US
Practice Address - Phone:917-683-6226
Practice Address - Fax:917-683-6226
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker