Provider Demographics
NPI:1144115098
Name:JOHNSON, KAITLIN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45950 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-6338
Mailing Address - Country:US
Mailing Address - Phone:607-344-1355
Mailing Address - Fax:607-344-1355
Practice Address - Street 1:22655 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3848
Practice Address - Country:US
Practice Address - Phone:301-507-9521
Practice Address - Fax:312-260-7996
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31585104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker