Provider Demographics
NPI:1518288141
Name:JOHNSON, MARIA (MARIA JOHNSON)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MARIA JOHNSON
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARIA JOHNSON
Mailing Address - Street 1:358 SINGINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2829
Mailing Address - Country:US
Mailing Address - Phone:631-419-6765
Mailing Address - Fax:
Practice Address - Street 1:358 SINGINGWOOD DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2829
Practice Address - Country:US
Practice Address - Phone:631-419-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist