Provider Demographics
NPI:1306062617
Name:JOHNSTON, PATRICIA MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EVES DRIVE GARDEN STATE BEHAVIORAL HEALTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-797-8777
Mailing Address - Fax:856-797-6764
Practice Address - Street 1:2 EVES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3193
Practice Address - Country:US
Practice Address - Phone:856-797-8777
Practice Address - Fax:856-797-6764
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00034200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11672844OtherCAQH ID