Provider Demographics
NPI:1083162812
Name:JOHNSON, DELORIS JEAN (MSSW, CSW)
Entity Type:Individual
Prefix:MS
First Name:DELORIS
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E. ST. CATHERINE ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:502-589-5080
Mailing Address - Fax:502-587-5009
Practice Address - Street 1:1022 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:502-589-6605
Practice Address - Fax:502-585-0335
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCSW#7211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker