Provider Demographics
NPI:1316080674
Name:JOHNSON, SUZANNE K (LCSW-R, MS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-R, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TWYLA PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1527
Mailing Address - Country:US
Mailing Address - Phone:716-983-0186
Mailing Address - Fax:
Practice Address - Street 1:5820 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5734
Practice Address - Country:US
Practice Address - Phone:716-983-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0727831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical