Provider Demographics
NPI:1003678764
Name:JOHNSON, ALBERT JOHN IV (LMSW)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:JOHN
Last Name:JOHNSON
Suffix:IV
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 MEADOWLARK LN SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1021
Mailing Address - Country:US
Mailing Address - Phone:505-737-1858
Mailing Address - Fax:
Practice Address - Street 1:4210 MEADOWLARK LN SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1021
Practice Address - Country:US
Practice Address - Phone:505-737-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2034-0051104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker