Provider Demographics
NPI:1588122253
Name:JOHNSON, CARISSA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 RUGER AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2603
Mailing Address - Country:US
Mailing Address - Phone:608-371-4392
Mailing Address - Fax:
Practice Address - Street 1:2315 RUGER AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2603
Practice Address - Country:US
Practice Address - Phone:608-322-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11058-C1041C0700X
MELC232451041C0700X
MALICSW1269881041C0700X
OHI.24059821041C0700X
WI113071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical