1285760330 NPI number — MS. CAROLE ELIZABETH JOHNSON RN, CS, LICSW

Table of content: MS. CAROLE ELIZABETH JOHNSON RN, CS, LICSW (NPI 1285760330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285760330 NPI number — MS. CAROLE ELIZABETH JOHNSON RN, CS, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CAROLE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CS, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON-TUKES
Provider Other First Name:
CAROLE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CS, LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285760330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9905 MAPLE LEAF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY VILLAGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20886-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-258-2765
Provider Business Mailing Address Fax Number:
301-740-3577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 E DEER PARK DR
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-881-4884
Provider Business Practice Location Address Fax Number:
301-740-3577
Provider Enumeration Date:
02/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  R084348 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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