Healthcare Provider Details

I. General information

NPI: 1407978216
Provider Name (Legal Business Name): THOMAS JOHNSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S HIRAM RD
HIRAM ME
04041-3636
US

IV. Provider business mailing address

363 DURGINTOWN RD
HIRAM ME
04041-3609
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-3208
  • Fax:
Mailing address:
  • Phone: 207-542-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC12299
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12299
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: