Provider Demographics
NPI:1750301107
Name:BARTON, JOHNNY MICHEAL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:MICHEAL
Last Name:BARTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:M
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1203 CASTINE CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2217
Mailing Address - Country:US
Mailing Address - Phone:301-802-1318
Mailing Address - Fax:301-316-4469
Practice Address - Street 1:1203 CASTINE CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2217
Practice Address - Country:US
Practice Address - Phone:301-802-1318
Practice Address - Fax:301-316-4469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD082121041C0700X
DCLC3008331041C0700X
VA09040060141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD386488OtherMEDICARE
MD7815913Medicaid