MEDICARE: CARL EDWARD JOHNSON MSW,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	LCS15212	CA

General Provider Information

NPI Number	:	1992887038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL EDWARD JOHNSON MSW,LCSW

Provider Business Mailing Address
First Line	:	12832 OLIVE ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2633
Country	:	US
Telephone Number	:	714-490-4952
Fax Number	:	714-895-8667

Provider Business Practice Location Address
First Line	:	12842 VALLEY VIEW ST
Second Line	:	STE #101
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2515
Country	:	US
Telephone Number	:	714-490-4952
Fax Number	:	714-895-8667

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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