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NPI Code Detail

MEDICARE: EUGENE P JOHNSON LISW-S

MEDICARE: EUGENE P JOHNSON LISW-S
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 WorkerI.0000223OH

General Provider Information

NPI Number : 1649512161
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUGENE P JOHNSON LISW-S
Provider Business Mailing Address
First Line : 4240 HUNT RD
Second Line :
City : BLUE ASH
State : OH
Zip : 45242-6612
Country : US
Telephone Number : 513-891-0650
Fax Number : 513-891-2838
Provider Business Practice Location Address
First Line : 830 EZZARD CHARLES DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-2525
Country : US
Telephone Number : 513-381-6672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2013
Last Update Date : 09/07/2023

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