Provider Demographics
NPI:1528583309
Name:JOHNSON, CARA (LSW)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:EREDICS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1 AURORA L GONZALEZ DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2783
Mailing Address - Country:US
Mailing Address - Phone:419-340-7879
Mailing Address - Fax:
Practice Address - Street 1:1 AURORA L GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2783
Practice Address - Country:US
Practice Address - Phone:419-340-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600142104100000X
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker