Provider Demographics
NPI:1609206226
Name:JOHNSON, LEROY CURTIS (MSW,ASW)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:CURTIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW,ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2353
Mailing Address - Country:US
Mailing Address - Phone:909-833-2986
Mailing Address - Fax:909-833-2998
Practice Address - Street 1:233 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2353
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:909-833-2998
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW35238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker