Individual
MR. KENNETH L JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
2305 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2515
(267) 307-2696
Mailing address
7804 THOURON AVE, PHILADELPHIA, PA 19150-2514
(267) 307-2696
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW131341
PA
Other
Enumeration date
07/22/2016
Last updated
07/22/2016
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