Provider Demographics
NPI:1255515482
Name:JOHNSON, ROSEMARY (PHD, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 MERIDENE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1942
Mailing Address - Country:US
Mailing Address - Phone:410-913-8662
Mailing Address - Fax:410-435-9118
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7532
Practice Address - Country:US
Practice Address - Phone:410-913-8662
Practice Address - Fax:410-435-9118
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD066251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158310700Medicaid