Healthcare Provider Details

I. General information

NPI: 1376783209
Provider Name (Legal Business Name): ELIZABETH ANNE J JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE ST ADOLESCENT MEDICINE J413
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ SUITE 200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5643
  • Fax: 859-323-3795
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3266
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: