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General NPI Number Information
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NPI Number | 1689690471
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Entity Type | Individual
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Provider Name | MARY M JOHNSTON LSCW
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 2113 STATE ST 1ST FLOOR
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City | NEW ALBANY
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State | IN
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Zip | 47150-4961
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Country | US
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Telephone | 812-949-3505
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Fax | 812-949-3505
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Provider Business Mailing Address
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Address Line | 1116 LAVISTA WAY
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City | LOUISVILLE
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State | KY
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Zip | 40219-2618
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Country | US
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Telephone | 502-969-2009
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3380
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004819A
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License Number State | IN
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