Provider Demographics
NPI:1861520413
Name:JOHNSON, MARJORIE R (DCSW)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 PRICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5517
Mailing Address - Country:US
Mailing Address - Phone:610-696-4443
Mailing Address - Fax:610-696-6467
Practice Address - Street 1:937 PRICHARD AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5517
Practice Address - Country:US
Practice Address - Phone:610-696-4443
Practice Address - Fax:610-696-6467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0112728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA65664Medicare ID - Type Unspecified