Provider Demographics
NPI:1477237121
Name:JOHNSON, MARILYN (MSW LSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SILVER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8575
Mailing Address - Country:US
Mailing Address - Phone:973-868-1227
Mailing Address - Fax:
Practice Address - Street 1:101 MOUNTAIN CT STE 101B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2300
Practice Address - Country:US
Practice Address - Phone:215-688-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133532104100000X
NJ44SL06248200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker