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NPI Code Detail

MEDICARE: MR. CLIFFORD JOHNSON ACSW,LCSW

MEDICARE: MR. CLIFFORD JOHNSON ACSW,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
11041C0700XClinical Social Worker000033CT

General Provider Information

NPI Number : 1952630519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLIFFORD JOHNSON ACSW,LCSW
Provider Business Mailing Address
First Line : 317 N MAIN ST
Second Line :
City : MANCHESTER
State : CT
Zip : 06042-2007
Country : US
Telephone Number : 860-643-2101
Fax Number : 860-645-1470
Provider Business Practice Location Address
First Line : 317 N MAIN ST
Second Line :
City : MANCHESTER
State : CT
Zip : 06042-2007
Country : US
Telephone Number : 860-643-2101
Fax Number : 860-645-1470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2009
Last Update Date : 12/10/2009

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