Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 089381-1 | NY |
NPI | 1003239591 |
---|---|
Provider Name | Ms. Laura Ann Johnson |
First Address | Albany, NY 12208-3103 |
Second Address | Albany, NY 12208-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2014 |
Last Update Date | 04/02/2014 |