Provider Demographics
NPI:1124380654
Name:JOHNSON, MARGUERITE BERNADETTE
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:BERNADETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HUGUENOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5200
Mailing Address - Country:US
Mailing Address - Phone:914-813-5051
Mailing Address - Fax:
Practice Address - Street 1:145 HUGUENOT ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5200
Practice Address - Country:US
Practice Address - Phone:914-813-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator