Provider Demographics
NPI:1942253877
Name:SUSAN A JOHNS LCSWC PA
Entity Type:Organization
Organization Name:SUSAN A JOHNS LCSWC PA
Other - Org Name:CENTER FOR WELL BEING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR AND CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, MSW
Authorized Official - Phone:410-744-2066
Mailing Address - Street 1:405 FREDERICK RD
Mailing Address - Street 2:SUITE 263
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4647
Mailing Address - Country:US
Mailing Address - Phone:410-744-2066
Mailing Address - Fax:
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 263
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4647
Practice Address - Country:US
Practice Address - Phone:410-744-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD069341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T4660001OtherBCBS FEDERAL
025945OtherVALUE OPTIONS
6216677OtherUNITED BEHAVIORAL HEALTH
MD053001800Medicaid
4671917OtherAETNA
IP273856OtherMAGELLAN
226385OtherKAISER PERMANENTE
MDKT20OtherBLUE CROSS BLUE SHIELD
119884OtherAPS
MDKT20OtherBLUE CROSS BLUE SHIELD
IP273856OtherMAGELLAN