Individual
JOHNSON DARAMOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
473 S 18TH ST, NEWARK, NJ 07103-1207
(862) 267-8249
Mailing address
473 S 18TH ST, NEWARK, NJ 07103-1207
(862) 267-8249
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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