Active NPI
Pamela Johnson
- Clinical Social Worker
- Ithaca, NY
National Provider Identifier
1235673559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 084163-1
- Practice address
- 405 Taughannock Blvd
Ithaca, NY 14850-3232 - Phone
- (607) 216-7412
- NPI assigned
- Dec 5, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 084163-1 | NY | Primary |
Addresses
Primary practice location
405 Taughannock Blvd
Ithaca, NY 14850-3232
Mailing address
405 Taughannock Blvd
Ithaca, NY 14850-3232
Phone (607) 216-7412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 084163-1 | NY | MD | Endocrinology, Diabetes & Metabolism Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480896000000",
"number": "1235673559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 TAUGHANNOCK BLVD",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503232",
"telephone_number": "607-216-7412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 TAUGHANNOCK BLVD",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503232",
"telephone_number": "607-216-7412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAMELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-05",
"last_updated": "2016-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "084163-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.