Provider Demographics
NPI:1023248226
Name:JOHNSON, STEPHANIE RENEE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 THOMAS JEFFERSON ST. NW
Mailing Address - Street 2:SUITE 420 EAST
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-903-4763
Mailing Address - Fax:202-333-0366
Practice Address - Street 1:1025 THOMAS JEFFERSON ST. NW
Practice Address - Street 2:SUITE 420 EAST
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-903-4763
Practice Address - Fax:202-333-0366
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
MD04553103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder