Individual
MARK J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
205 S FRONT ST, 5TH FLOOR BMA, HARRISBURG, PA 17104-1619
(717) 231-8360
(717) 231-8358
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
(717) 231-8360
(717) 231-8358
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS015349
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103002852
—
PA
Enumeration date
01/22/2015
Last updated
01/19/2021
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