MEDICARE: AESHA A. JOHNSON LGSW

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	104100000X	Social Worker	16684	MD

General Provider Information

NPI Number	:	1225396195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AESHA A. JOHNSON LGSW

Provider Business Mailing Address
First Line	:	1111 KENOSHA AVE
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-8923
Country	:	US
Telephone Number	:	410-603-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 AIRPAX RD
Second Line	:	BLDG B STE 300
City	:	CAMBRIDGE
State	:	MD
Zip	:	21613-6401
Country	:	US
Telephone Number	:	410-228-3929
Fax Number	:	410-228-3810

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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