Healthcare Provider Details

I. General information

NPI: 1871096321
Provider Name (Legal Business Name): ROBERT BENNETT JOHNSON LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEXINGTON AVE
ASHLAND KY
41101-2873
US

IV. Provider business mailing address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-7800
  • Fax: 606-408-6800
Mailing address:
  • Phone: 740-354-6685
  • Fax: 740-876-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1000032-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number260304
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: