Provider Demographics
NPI:1407000185
Name:JOHNSON, KRISTEN A (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 GLADE CT
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6605
Mailing Address - Country:US
Mailing Address - Phone:301-703-2041
Mailing Address - Fax:
Practice Address - Street 1:10803 GLADE CT
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6605
Practice Address - Country:US
Practice Address - Phone:301-703-2041
Practice Address - Fax:866-298-8206
Is Sole Proprietor?:No
Enumeration Date:2008-11-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-06-3092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst