Provider Demographics
NPI:1972570364
Name:JOHNSEN, ANGELA D (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:204 COOK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9600
Mailing Address - Country:US
Mailing Address - Phone:513-228-7800
Mailing Address - Fax:513-725-2231
Practice Address - Street 1:204 COOK RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-228-7800
Practice Address - Fax:513-725-2231
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0008277-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000246037OtherANTHEM PIN
11689424OtherCAQH #
OH000000246037OtherANTHEM PIN