Individual
CAMELLIA A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW,MSW,BA
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9336
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008064941
—
CT
01
—
060669107
OPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT
01
—
13671479
CAQH
CT
01
—
PENDING
MHN MANAGED HEALTH NETWORK
CT
01
—
TORRINGTON D339230
BEACON HEALTH
CT
Enumeration date
07/10/2013
Last updated
08/29/2016
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