Healthcare Provider Details

I. General information

NPI: 1073289880
Provider Name (Legal Business Name): DANELY JOHNSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SULGRAVE AVE STE 200
BALTIMORE MD
21209-3650
US

IV. Provider business mailing address

6002 FALLFISH CT
NEW MARKET MD
21774-6880
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5856
  • Fax:
Mailing address:
  • Phone: 301-906-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: