Provider Demographics
NPI:1306589338
Name:JOHNSON, LYNETTE LORRAINE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:LORRAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 DERBY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1869
Mailing Address - Country:US
Mailing Address - Phone:513-827-6404
Mailing Address - Fax:513-827-6404
Practice Address - Street 1:730 DERBY AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1869
Practice Address - Country:US
Practice Address - Phone:513-827-6404
Practice Address - Fax:513-827-6404
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH112OtherHOME CARE