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NPI Code Detail

MEDICARE: MS. CAROL MARTIN JOHNSON MA, ATR-BC, LPC

MEDICARE: MS. CAROL MARTIN JOHNSON MA, ATR-BC, LPC
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
1101YP2500XProfessional Counselor004304PA

General Provider Information

NPI Number : 1114363140
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL MARTIN JOHNSON MA, ATR-BC, LPC
Provider Business Mailing Address
First Line : 4900 SPRUCE ST UNIT 502
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19139-4372
Country : US
Telephone Number : 267-608-5354
Fax Number :
Provider Business Practice Location Address
First Line : 4919 PENTRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19143-3320
Country : US
Telephone Number : 267-608-5354
Fax Number : 610-387-6056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2013
Last Update Date : 11/18/2024

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