Provider Demographics
NPI:1750910063
Name:JOHNSEN, MARIA (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:POULAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3510 HOMELAND TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1760
Mailing Address - Country:US
Mailing Address - Phone:301-221-2124
Mailing Address - Fax:
Practice Address - Street 1:3510 HOMELAND TER
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1760
Practice Address - Country:US
Practice Address - Phone:301-221-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24920104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker