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NPI Code Detail

MEDICARE: MONIFA N JOHNSON LCSW-C, LICSW, LCSW

MEDICARE: MONIFA N JOHNSON LCSW-C, LICSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLC50080652DC

General Provider Information

NPI Number : 1972950350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIFA N JOHNSON LCSW-C, LICSW, LCSW
Provider Business Mailing Address
First Line : 11942 TWINLAKES DR
Second Line : 33
City : BELTSVILLE
State : MD
Zip : 20705-3183
Country : US
Telephone Number : 240-716-0552
Fax Number :
Provider Business Practice Location Address
First Line : 3341 BENNING RD NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-1502
Country : US
Telephone Number : 202-543-0387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 05/16/2016

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