Active NPI
Raynell Cecilia Johnson, PHD
- Psychologist
- Bowie, MD
National Provider Identifier
1861534448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 04356
- Practice address
- 3060 Mitchellville Rd #212
Bowie, MD 20716 - Phone
- (301) 218-5492
- Fax
- (301) 218-9514
- NPI assigned
- Feb 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 04356 | MD | Primary |
| Psychologist | 103T00000X | PSY1000321 | DC |
Addresses
Primary practice location
3060 Mitchellville Rd #212
Bowie, MD 20716
Mailing address
901 James Ridge Road
Bowie, MD 20721
Phone (301) 218-4748
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY1000321 | DC | MD | Psychologist |
| 04356 | MD | MD | Hand Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861534448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 JAMES RIDGE ROAD",
"city": "BOWIE",
"state": "MD",
"postal_code": "20721",
"telephone_number": "301-218-4748",
"fax_number": "301-218-4657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3060 MITCHELLVILLE RD #212",
"city": "BOWIE",
"state": "MD",
"postal_code": "20716",
"telephone_number": "301-218-5492",
"fax_number": "301-218-9514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RAYNELL",
"middle_name": "CECILIA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "04356",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "DC",
"license": "PSY1000321",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.