MEDICARE: ALVA JOHNSON LSW

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	104100000X	Social Worker	SW132280	PA

General Provider Information

NPI Number	:	1548657174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVA JOHNSON LSW

Provider Business Mailing Address
First Line	:	7601 GERMANTOWN AVE
Second Line	:	SUITE B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1608
Country	:	US
Telephone Number	:	215-753-1330
Fax Number	:	215-753-1331

Provider Business Practice Location Address
First Line	:	7601 GERMANTOWN AVE
Second Line	:	SUITE B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1608
Country	:	US
Telephone Number	:	215-753-1330
Fax Number	:	215-753-1331

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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Directions to “ ALVA JOHNSON LSW” Practice Location

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