MEDICARE: JAMIE J. JOHNSON LCSW,MPH

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	SW4061	FL
2	222Q00000X	Developmental Therapist	SW4061	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245392927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE J. JOHNSON LCSW,MPH

Provider Business Mailing Address
First Line	:	7108 S MASCOTTE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-2719
Country	:	US
Telephone Number	:	813-784-8062
Fax Number	:

Provider Business Practice Location Address
First Line	:	7108 S MASCOTTE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-2719
Country	:	US
Telephone Number	:	813-784-8062
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/20/2015

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