Provider Demographics
NPI:1932587953
Name:JOHNSON, DANIEL SCOTT JR (MS, BCBA, LABA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4445
Mailing Address - Country:US
Mailing Address - Phone:802-277-1141
Mailing Address - Fax:
Practice Address - Street 1:53 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4445
Practice Address - Country:US
Practice Address - Phone:802-277-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst