Provider Demographics
NPI:1962482208
Name:JOHNSON, ROBERT W (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:JOHNSON
Suffix:
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 1:2800 SOUTH MACGREGOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-0769
Mailing Address - Country:US
Mailing Address - Phone:713-741-5000
Mailing Address - Fax:713-741-5049
Practice Address - Street 1:2800 SOUTH MACGREGOR WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-0769
Practice Address - Country:US
Practice Address - Phone:713-741-5000
Practice Address - Fax:713-741-5049
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0053181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A7351Medicare PIN