Provider Demographics
NPI:1790794725
Name:JOHNSON, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:9350 AFTERNOON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3902
Mailing Address - Country:US
Mailing Address - Phone:410-730-4217
Mailing Address - Fax:443-542-9135
Practice Address - Street 1:9350 AFTERNOON LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3902
Practice Address - Country:US
Practice Address - Phone:410-730-4217
Practice Address - Fax:443-542-9135
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD061611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE271Medicare UPIN