MEDICARE: MICHAEL EDWARD JOHNSON MSW,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
1	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker	6801062830	MI

General Provider Information

NPI Number	:	1245364199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EDWARD JOHNSON MSW,LMSW

Provider Business Mailing Address
First Line	:	1349 WAGON WHEEL RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1156
Country	:	US
Telephone Number	:	313-806-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 TRUMBULL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1368
Country	:	US
Telephone Number	:	313-964-2030
Fax Number	:	313-964-2092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/29/2021

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