MEDICARE: SCOTT J JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	126917	MA
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467063982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT J JOHNSON LCSW

Provider Business Mailing Address
First Line	:	195 STATEN ISLAND AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-7440
Country	:	US
Telephone Number	:	312-315-2537
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 E TROPICANA AVE # 144
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6564
Country	:	US
Telephone Number	:	312-315-2537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	11/09/2023

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Directions to “ SCOTT J JOHNSON LCSW” Practice Location

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