Provider Demographics
NPI:1427550839
Name:JOHNSON, MAURA LYNN
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:LYNN
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 1:100 NORTHPOINTE CIR STE 306
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7851
Mailing Address - Country:US
Mailing Address - Phone:724-772-4848
Mailing Address - Fax:724-772-4848
Practice Address - Street 1:3402 WASHINGTON RD STE 304
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2964
Practice Address - Country:US
Practice Address - Phone:724-941-5363
Practice Address - Fax:724-941-5464
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical