Healthcare Provider Details

I. General information

NPI: 1275623647
Provider Name (Legal Business Name): GEORGE HEATON JOHNSON III L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MEADOW LN
NEW HOPE PA
18938-1050
US

IV. Provider business mailing address

PO BOX 57
NEW HOPE PA
18938-0057
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-5175
  • Fax:
Mailing address:
  • Phone: 215-345-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW011694L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04548000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: