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NPI Code Detail

MEDICARE: MOLLY JOHNSON

MEDICARE: MOLLY 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
1101YM0800XMental Health CounselorSW-GTL-20-01700NJ
21041C0700XClinical Social Worker44SC06260700NJ

General Provider Information

NPI Number : 1114481132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY JOHNSON
Provider Business Mailing Address
First Line : 11 LEES AVE APT 1
Second Line :
City : COLLINGSWOOD
State : NJ
Zip : 08108-1925
Country : US
Telephone Number : 609-317-6916
Fax Number :
Provider Business Practice Location Address
First Line : 1103 SHEPPARD RD
Second Line :
City : VOORHEES
State : NJ
Zip : 08043-4797
Country : US
Telephone Number : 856-625-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2019
Last Update Date : 12/02/2025

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