Provider Demographics
NPI:1841686086
Name:JENNIFER G. JOHNSON
Entity type:Organization
Organization Name:JENNIFER G. JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, B-C, CARN
Authorized Official - Phone:410-776-3652
Mailing Address - Street 1:7801 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7449
Mailing Address - Country:US
Mailing Address - Phone:410-337-0720
Mailing Address - Fax:410-337-0714
Practice Address - Street 1:7801 YORK RD STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7449
Practice Address - Country:US
Practice Address - Phone:410-337-0720
Practice Address - Fax:410-337-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189440261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184027484Medicaid