Provider Demographics
NPI:1063704336
Name:JOHNSON, SUSAN RENEE (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SPRING ST
Mailing Address - Street 2:#1021
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4022
Mailing Address - Country:US
Mailing Address - Phone:301-785-6189
Mailing Address - Fax:
Practice Address - Street 1:1001 SPRING ST
Practice Address - Street 2:#1021
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4022
Practice Address - Country:US
Practice Address - Phone:301-785-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078404104100000X
MDG13101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker