Provider Demographics
NPI:1619014552
Name:JOHNSON, MARIEKE D
Entity Type:Individual
Prefix:
First Name:MARIEKE
Middle Name:D
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 1:722 MONTCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2854
Mailing Address - Country:US
Mailing Address - Phone:412-461-1004
Mailing Address - Fax:412-461-1325
Practice Address - Street 1:1705 MAPLE ST
Practice Address - Street 2:STE B3
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1800
Practice Address - Country:US
Practice Address - Phone:412-461-1004
Practice Address - Fax:412-461-1325
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker