Provider Demographics
NPI:1851819494
Name:JOHNSON, MEREDITH JILLIAN (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JILLIAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-4205
Mailing Address - Country:US
Mailing Address - Phone:914-588-2521
Mailing Address - Fax:
Practice Address - Street 1:344 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1921
Practice Address - Country:US
Practice Address - Phone:914-588-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007060101YM0800X
CT46.004982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty