MEDICARE: MRS. TERI M JOHNSON LICSW

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	1041C0700X	Clinical Social Worker	LC302294	DC

General Provider Information

NPI Number	:	1881757847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERI M JOHNSON LICSW

Provider Business Mailing Address
First Line	:	4201 CONNECTICUT AVE NW
Second Line	:	SUITE 300
City	:	WASHINGTON
State	:	DC
Zip	:	20008-1158
Country	:	US
Telephone Number	:	202-624-0010
Fax Number	:	202-624-0062

Provider Business Practice Location Address
First Line	:	4201 CONNECTICUT AVE NW
Second Line	:	SUITE 300
City	:	WASHINGTON
State	:	DC
Zip	:	20008-1158
Country	:	US
Telephone Number	:	202-624-0010
Fax Number	:	202-624-0062

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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