Provider Demographics
NPI:1306909601
Name:JOHNSTON, LISABETH EMERSON (PHD APRN)
Entity type:Individual
Prefix:DR
First Name:LISABETH
Middle Name:EMERSON
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD APRN
Other - Prefix:
Other - First Name:LISABETH
Other - Middle Name:EMERSON
Other - Last Name:FENDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 WHITING LANE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-233-4305
Mailing Address - Fax:860-233-4305
Practice Address - Street 1:361 PARK ROAD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-523-1101
Practice Address - Fax:860-233-4305
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000355364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004645744OtherAETNA
692201OtherPACIFICARE
6197478OtherUNITED BEHAVIORAL HEALTH
ZA8706OtherHEALTH NET
P2742846OtherOXFORD
135998OtherVALUE OPTIONS
168777OtherMHN
400000355CT03OtherBLUE CROSS & BLUE SHIELD
400000355CT03OtherBLUE CROSS & BLUE SHIELD
692201OtherPACIFICARE
890000036Medicare ID - Type Unspecified