Provider Demographics
NPI:1063533990
Name:JOHNSON, EILEEN W (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2031
Mailing Address - Country:US
Mailing Address - Phone:207-729-5644
Mailing Address - Fax:207-729-5699
Practice Address - Street 1:98 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2031
Practice Address - Country:US
Practice Address - Phone:207-729-5644
Practice Address - Fax:207-729-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC46031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical