Healthcare Provider Details

I. General information

NPI: 1669772455
Provider Name (Legal Business Name): HARPER BAILEY JOHNSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W ROGERS AVE
BALTIMORE MD
21209-4596
US

IV. Provider business mailing address

1708 W ROGERS AVE
BALTIMORE MD
21209-4596
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-7090
  • Fax: 410-367-4197
Mailing address:
  • Phone: 410-578-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number05285
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number05285
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number05285
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number05285
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number05285
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: