=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962917781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HARMON JOHNSON SR. MSW, LSW, LICDC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2017
-----------------------------------------------------
Last Update Date | 08/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 PLEASANT AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-868-4863
-----------------------------------------------------
Fax | 513-568-1415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2250 PLEASANT AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45015-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-868-4863
-----------------------------------------------------
Fax | 513-568-1415
-----------------------------------------------------
=====================================================
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 | S1502521
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------