Provider Demographics
NPI:1730292152
Name:JOHNSON, RITA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21943 VERNON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5317
Mailing Address - Country:US
Mailing Address - Phone:847-367-6900
Mailing Address - Fax:847-816-6447
Practice Address - Street 1:1117 S MILWAUKEE AVE
Practice Address - Street 2:FORUM SQR BLDG B STE 2
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3798
Practice Address - Country:US
Practice Address - Phone:847-367-6900
Practice Address - Fax:847-816-6447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical