Provider Demographics
NPI:1396142881
Name:JOHNSON, LATOYA JEANEEN (LMHC)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:JEANEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1157
Mailing Address - Country:US
Mailing Address - Phone:845-794-8080
Mailing Address - Fax:845-794-8343
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1157
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-794-8343
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004883-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health