Provider Demographics
NPI:1043623721
Name:JOHNSON, TROY (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W BELMONT AVE APT 10H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4723
Mailing Address - Country:US
Mailing Address - Phone:773-875-0928
Mailing Address - Fax:
Practice Address - Street 1:420 W BELMONT AVE APT 10H
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4723
Practice Address - Country:US
Practice Address - Phone:773-875-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490182631041C0700X
171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator