MEDICARE: CARMEN ELISE JOHNSON LCSW

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	34009101A	IN

General Provider Information

NPI Number	:	1669896320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN ELISE JOHNSON LCSW

Provider Business Mailing Address
First Line	:	5577 GOODWIN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-5501
Country	:	US
Telephone Number	:	317-997-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 E 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1806
Country	:	US
Telephone Number	:	317-997-9676
Fax Number	:

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	07/22/2025

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