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General NPI Number Information
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NPI Number | 1033443635
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Entity Type | Individual
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Provider Name | CHERYL E JOHNSON LBSW
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Gender | Female
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 3539 E 30TH ST
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City | FARMINGTON
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State | NM
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Zip | 87402-8801
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Country | US
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Telephone | 505-566-3859
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Fax | 505-566-3826
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Provider Business Mailing Address
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Address Line | 4601 COLLEGE BLVD
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City | FARMINGTON
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State | NM
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Zip | 87402-4609
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Country | US
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Telephone | 505-566-3859
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Fax | 505-566-3826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | B-05517
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License Number State | NM
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