MEDICARE: MARCIE JOHNSON PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	06895	MD

General Provider Information

NPI Number	:	1316668254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE JOHNSON PHD

Provider Business Mailing Address
First Line	:	6 WINDSONG CT
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-1929
Country	:	US
Telephone Number	:	443-858-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1447 YORK RD STE 701
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6089
Country	:	US
Telephone Number	:	443-914-3319
Fax Number	:

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	03/13/2023

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Directions to “ MARCIE JOHNSON PHD” Practice Location

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