Provider Demographics
NPI:1538526231
Name:JOHNSON, KIMBERLY ROSS (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OLD KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4526
Mailing Address - Country:US
Mailing Address - Phone:203-978-3000
Mailing Address - Fax:
Practice Address - Street 1:30 OLD KINGS HWY S
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4526
Practice Address - Country:US
Practice Address - Phone:203-978-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist