1083681225 NPI number — MRS. BRENDA WEBB JOHNSON LCSW

Table of content: MRS. BRENDA WEBB JOHNSON LCSW (NPI 1083681225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083681225 NPI number — MRS. BRENDA WEBB JOHNSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
BRENDA
Provider Middle Name:
WEBB
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083681225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7316 NIGHT HERON DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-972-2000
Provider Business Mailing Address Fax Number:
813-978-5913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JAMES A HALEY VAMC
Provider Second Line Business Practice Location Address:
13000 BRUCE B DOWNS BLVD.
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-972-2000
Provider Business Practice Location Address Fax Number:
813-978-5913
Provider Enumeration Date:
03/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW002328 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)