Provider Demographics
NPI:1932748563
Name:JOHNSON, BRE-ANNA MICHELE
Entity type:Individual
Prefix:
First Name:BRE-ANNA
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 WASHINGTON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1348
Mailing Address - Country:US
Mailing Address - Phone:631-987-1462
Mailing Address - Fax:
Practice Address - Street 1:855 ROUTE 146 STE 220
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3890
Practice Address - Country:US
Practice Address - Phone:518-934-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health