MEDICARE: SEMIKAH YISRAEL-JOHNSON LCMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LCM657	MD

General Provider Information

NPI Number	:	1053810176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEMIKAH YISRAEL-JOHNSON LCMFT

Provider Business Mailing Address
First Line	:	12138 CENTRAL AVE STE 145
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1910
Country	:	US
Telephone Number	:	202-681-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MERCANTILE LN STE 208
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5350
Country	:	US
Telephone Number	:	202-681-5226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2018
Last Update Date	:	02/04/2018

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