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General NPI Number Information
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NPI Number | 1669896320
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Entity Type | Individual
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Provider Name | CARMEN ELISE JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 802 E 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1806
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Country | US
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Telephone | 317-997-9676
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Fax |
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Provider Business Mailing Address
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Address Line | 5577 GOODWIN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-5501
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Country | US
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Telephone | 317-997-7659
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34009101A
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License Number State | IN
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