1952379331 NPI number — MRS. SUSAN T JOHNSON MS LICSW BCD

Table of content: MRS. SUSAN T JOHNSON MS LICSW BCD (NPI 1952379331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952379331 NPI number — MRS. SUSAN T JOHNSON MS LICSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
SUSAN
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS LICSW BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOWNSEND
Provider Other First Name:
SUSAN
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS IN SOCIAL WORK
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952379331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 GOLDENCREST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-803-5750
Provider Business Mailing Address Fax Number:
781-290-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 GOLDENCREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-803-5750
Provider Business Practice Location Address Fax Number:
781-290-0130
Provider Enumeration Date:
03/10/2006

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: 1041C0700X , with the licence number:  103125 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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