Charlie-Mae Johnson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089.0136799PROV Issued in VT

Practice address

5 Pilgrim Park Rd
Waterbury, VT 05676-1735

Phone

(802) 474-1878

NPI assigned

Dec 11, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1765411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1013871219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 DALTON RD",
            "city": "DALTON",
            "state": "NH",
            "postal_code": "035985723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PILGRIM PARK RD",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761735",
            "telephone_number": "802-474-1878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHARLIE-MAE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-11",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0136799PROV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Ireland
• Peter James Ireland, MD
• Allison Jacob, LAC
• Yougyeoung Jho
• Brittany Johnson, PHARMD
• Justin Karlitz-Grodin, M.D.
• Kamala Jean Kelton, LCMHC
• Astrid Kempainen
• KPH Healthcare Services, Inc. (Kinney Drugs #101)
• Nicole R Krotinger, MS, LCMHC

• Clinical Social Worker in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.