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General NPI Number Information
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NPI Number | 1508005299
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Entity Type | Individual
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Provider Name | MICHAEL P. JOHNSON L.M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 3297 BAILEY AVE
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City | BUFFALO
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State | NY
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Zip | 14215-1139
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Country | US
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Telephone | 716-833-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 871 DELAWARE AVE APT 12
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City | BUFFALO
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State | NY
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Zip | 14209-2036
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Country | US
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Telephone | 585-507-8656
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Fax |
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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 | 078123
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R077963
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License Number State | NY
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