Provider Demographics
NPI:1275623647
Name:JOHNSON, GEORGE HEATON III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HEATON
Last Name:JOHNSON
Suffix:III
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-0057
Mailing Address - Country:US
Mailing Address - Phone:215-345-5175
Mailing Address - Fax:
Practice Address - Street 1:24 MEADOW LN
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1050
Practice Address - Country:US
Practice Address - Phone:215-345-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045480001041C0700X
PASW011694L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker