Keniesha Johnson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

008593 Issued in CT

Practice address

4 Banfield LN
Bloomfield, CT 06002-2807

Phone

(860) 680-4240

NPI assigned

May 23, 2017

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• My Mind Matters

  • Clinical Social Worker
  • Bloomfield, CT
  • NPI 1316625080
  NPD

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495497600000",
    "number": "1194253039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BANFIELD LN",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022807",
            "telephone_number": "860-680-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 BANFIELD LN",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022807",
            "telephone_number": "860-680-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENIESHA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-23",
        "last_updated": "2017-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliman K Jeng
• Jennifer W Pennoyer MD LLC
• Jill R. Cristo Ma LMFT LLC
• Joel M. Miller M.D. PC
• Lisa M Johnson-Holloway, L.C.S.W.
• Samantha Johnson
• Michelle A Joiner
• Wanda Jones, CMAA
• Akesha Marie Jordan, LMSW
• Krystle Jordan, MFT

• Clinical Social Worker in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.