=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871096321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT BENNETT JOHNSON LISW-S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2018
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 LEXINGTON AVE
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41101-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-408-7800
-----------------------------------------------------
Fax | 606-408-6800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 COURT ST
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-3932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-354-6685
-----------------------------------------------------
Fax | 740-876-4005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | I.1000032-SUPV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 260304
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------