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NPI Code Detail

MEDICARE: EILEEN W. JOHNSON LCSW

MEDICARE:   EILEEN W. JOHNSON  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLC4603ME

General Provider Information

NPI Number : 1063533990
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILEEN W. JOHNSON LCSW
Provider Business Mailing Address
First Line : 98 MAINE ST
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2031
Country : US
Telephone Number : 207-729-5644
Fax Number : 207-729-5699
Provider Business Practice Location Address
First Line : 98 MAINE ST
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2031
Country : US
Telephone Number : 207-729-5644
Fax Number : 207-729-5699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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Directions to “ EILEEN W. JOHNSON LCSW” Practice Location

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