Provider Demographics
NPI:1316241334
Name:JOHNSTON, JENNIFER ANN (MA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:YADON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:125 HEPBURN RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2925
Mailing Address - Country:US
Mailing Address - Phone:617-699-3101
Mailing Address - Fax:
Practice Address - Street 1:375 MATHER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3101
Practice Address - Country:US
Practice Address - Phone:617-699-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013824101YM0800X
CT2205101YP2500X
MA000007570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional