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NPI Code Detail

MEDICARE: PAULA ANN JOHNSON I LMSW

MEDICARE: PAULA ANN JOHNSON I LMSW
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 Worker17053AZ

General Provider Information

NPI Number : 1184122558
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA ANN JOHNSON I LMSW
Provider Business Mailing Address
First Line : 2102 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1935
Country : US
Telephone Number : 602-774-4745
Fax Number :
Provider Business Practice Location Address
First Line : 2102 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1935
Country : US
Telephone Number : 602-774-4745
Fax Number : 602-449-0032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2018
Last Update Date : 01/31/2018

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