Provider Demographics
NPI:1316959174
Name:JOHNSON, STEWART (LCSW)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 WASHINGTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2534
Mailing Address - Country:US
Mailing Address - Phone:724-941-1120
Mailing Address - Fax:724-941-0993
Practice Address - Street 1:4150 WASHINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2534
Practice Address - Country:US
Practice Address - Phone:724-941-1120
Practice Address - Fax:724-941-0993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098906Medicare ID - Type Unspecified