Provider Demographics
NPI:1083628762
Name:JOHNSON, KAREN S (LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 STATE ROUTE 101A
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2248
Mailing Address - Country:US
Mailing Address - Phone:603-595-8555
Mailing Address - Fax:603-595-8555
Practice Address - Street 1:135 STATE ROUTE 101A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2248
Practice Address - Country:US
Practice Address - Phone:603-595-8555
Practice Address - Fax:603-595-8555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3071845Medicaid
NHRE4766Medicare ID - Type Unspecified