Provider Demographics
NPI:1871865162
Name:JOHNSON, MAUREEN P (MA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11577 NW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7153
Mailing Address - Country:US
Mailing Address - Phone:954-549-4481
Mailing Address - Fax:954-549-4481
Practice Address - Street 1:7710 NW 71ST CT STE 206
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2931
Practice Address - Country:US
Practice Address - Phone:954-549-4481
Practice Address - Fax:954-549-4481
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL20301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator