Individual
KENIESHA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4 BANFIELD LN, BLOOMFIELD, CT 06002-2807
(860) 680-4240
Mailing address
4 BANFIELD LN, BLOOMFIELD, CT 06002-2807
(860) 680-4240
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008593
CT
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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