Healthcare Provider Details

I. General information

NPI: 1013823863
Provider Name (Legal Business Name): ROSE & JOHNSON PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 PICKERING DR APT D
BALTIMORE MD
21234-7326
US

IV. Provider business mailing address

2409 PICKERING DR APT D
BALTIMORE MD
21234-7326
US

V. Phone/Fax

Practice location:
  • Phone: 856-263-4936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARRAKESH SHILOH ROSE
Title or Position: SOCIAL WORKER
Credential: LCSW-C
Phone: 856-263-4936