Provider Demographics
NPI:1366980419
Name:JOHNSON, LESSIE LYNETTE (LMSW)
Entity type:Individual
Prefix:
First Name:LESSIE
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N. MAIN ST AVE
Mailing Address - Street 2:ST. CATHERINES CENTER FOR CHILDREN
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-453-6700
Mailing Address - Fax:
Practice Address - Street 1:40 N. MAIN AVE
Practice Address - Street 2:ST. CATHERINE'S CENTER FOR CHILDREN
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-453-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097737104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker