=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295758589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERA-MARIE C. JOHNSON LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 PICCARD DR 2ND FLOOR
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-4320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-777-4096
-----------------------------------------------------
Fax | 240-777-4100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25110 HIGHLAND MANOR CT
-----------------------------------------------------
City | LAYTONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20882-3732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-482-1038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 04516
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------