Provider Demographics
NPI:1154896298
Name:JOHNSON, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6354
Mailing Address - Country:US
Mailing Address - Phone:508-469-3269
Mailing Address - Fax:
Practice Address - Street 1:144 MERRIMACK ST STE 302
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1710
Practice Address - Country:US
Practice Address - Phone:978-677-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2019-05-16
Deactivation Date:2019-05-10
Deactivation Code:
Reactivation Date:2019-05-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health