Timothy Johnston, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

118929 Issued in NY

Practice address

950 Danby Rd Ste 202F
Ithaca, NY 14850-5714

Phone

(607) 260-3100

NPI assigned

Sep 6, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 10, 2026 through May 10, 2028

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.

• Mindwell Psychology, LLP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ithaca, NY
  • NPI 1255944377
  NPD
• Healing Room Inc.

  • Clinical Social Worker
  • State College, PA
  • NPI 1033501523
  NPD
• Mindwell Psychological Assessment, LLP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Latham, NY
  • NPI 1902536410
  NPD (past)

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1568183762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 DANBY RD STE 202F",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505714",
            "telephone_number": "072-603-1006",
            "fax_number": "607-241-9972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 DANBY RD STE 202F",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505714",
            "telephone_number": "607-260-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2023 Cato Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "State College",
            "state": "PA",
            "postal_code": "168012765",
            "country_code": "US",
            "telephone_number": "814-308-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "TIMOTHY",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-06",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "118929",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW139720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jarred Johnson, M.D.
• Kasandra Johnson, BS, ATC
• Pamela Johnson
• Anthony M. L. Johnston, LCSW
• Brianna Teresa Johnston, DPT
• Nazreenbanu Jolly, PA-C
• Elizabeth Jonas
• Bonnielyn F. Jones, RN
• Cayla Krista Jones, OTR/L
• Christopher Jones, LMSW

• Clinical Social Worker in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.