1528707650 NPI number — CATHERINE AMANDA JOHNSON MS, MA

Table of content: CATHERINE AMANDA JOHNSON MS, MA (NPI 1528707650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528707650 NPI number — CATHERINE AMANDA JOHNSON MS, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CATHERINE
Provider Middle Name:
AMANDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528707650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1133 WESTCHESTER AVE STE N-006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10604-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-539-7600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
84 ANTIETAM STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
DEVENS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-451-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com