Provider Demographics
NPI:1538608401
Name:JOHNSON, EMMANUETTE (LCSW)
Entity type:Individual
Prefix:
First Name:EMMANUETTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMMANUETTE
Other - Middle Name:
Other - Last Name:JEAN BAPTISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 822021
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-2021
Mailing Address - Country:US
Mailing Address - Phone:305-707-4240
Mailing Address - Fax:
Practice Address - Street 1:15800 PINES BLVD STE 328
Practice Address - Street 2:
Practice Address - City:PEMBROKE PNES
Practice Address - State:FL
Practice Address - Zip Code:33027-1212
Practice Address - Country:US
Practice Address - Phone:305-707-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW170741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical