Provider Demographics
NPI:1518323963
Name:JOHNSON LOWERY, JENINE
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:
Last Name:JOHNSON LOWERY
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 1:7813 MONTGOMERY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2608
Mailing Address - Country:US
Mailing Address - Phone:267-588-2584
Mailing Address - Fax:
Practice Address - Street 1:7813 MONTGOMERY AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2608
Practice Address - Country:US
Practice Address - Phone:215-703-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health