MEDICARE: RENAYLA J JOHNSON

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	106S00000X	Behavior Technician		MD

General Provider Information

NPI Number	:	1073479432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAYLA J JOHNSON

Provider Business Mailing Address
First Line	:	640 FREEDOM BUSINESS CTR DR STE 220
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-1376
Country	:	US
Telephone Number	:	484-965-9966
Fax Number	:

Provider Business Practice Location Address
First Line	:	11921 BOURNEFIELD WAY STE A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7815
Country	:	US
Telephone Number	:	484-965-9966
Fax Number	:

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

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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