Provider Demographics
NPI:1366590515
Name:JOHNSON, RUTH E (MSN, CNM, CS)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, CNM, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7128
Mailing Address - Country:US
Mailing Address - Phone:781-643-1263
Mailing Address - Fax:
Practice Address - Street 1:42 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1803
Practice Address - Country:US
Practice Address - Phone:781-431-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196057163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA55001005881OtherPACIFICARE PROVIDER NUMBE
MA7902642OtherAETNA PROVIDER NUMBER
MAPN0768OtherBCBSMA PROVIDER NUMBER
MA7902642OtherAETNA PROVIDER NUMBER