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General NPI Number Information
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NPI Number | 1417305814
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Entity Type | Individual
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Provider Name | MARA JOHNSON LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 115 BROADWAY STE 1800
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City | NEW YORK
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State | NY
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Zip | 10006-1652
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Country | US
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Telephone | 347-835-0973
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Fax |
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Provider Business Mailing Address
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Address Line | 90 BROAD ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10004-3313
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Country | US
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Telephone | 347-620-3038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004822
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License Number State | NY
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