Active NPI
Joan Johanesen, MSW, PHD
- Clinical Social Worker
- Titusville, FL
National Provider Identifier
1962794552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW2149
- Practice address
- 4485 Elliot Ave
Titusville, FL 32780-6416 - Phone
- (321) 225-9315
- NPI assigned
- May 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ISW2149 | FL | Primary |
Addresses
Primary practice location
4485 Elliot Ave
Titusville, FL 32780-6416
Mailing address
4485 Elliot Ave
Titusville, FL 32780-6416
Phone (321) 225-9315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ISW2149 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305244800000",
"number": "1962794552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4485 ELLIOT AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327806416",
"telephone_number": "321-225-9315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4485 ELLIOT AVE",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327806416",
"telephone_number": "321-225-9315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANESEN",
"first_name": "JOAN",
"credential": "MSW, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-13",
"last_updated": "2011-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "ISW2149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.