MEDICARE: EILEEN W. JOHNSON, LCSW, LLC

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
1	1041C0700X	Clinical Social Worker	LC4603	ME

General Provider Information

NPI Number	:	1184871196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EILEEN W. JOHNSON, LCSW, LLC

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	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	EILEEN W. JOHNSON
Credential	:	LCSW
Telephone Number	:	207-729-5644

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	08/20/2008

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