Provider Demographics
NPI:1386063915
Name:JOHNSON, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
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 1:95 PLEASANT ST
Mailing Address - Street 2:LYNN CBFS
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901
Mailing Address - Country:US
Mailing Address - Phone:781-715-2340
Mailing Address - Fax:781-715-2388
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:LYNN CBFS
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:781-715-2340
Practice Address - Fax:781-715-2388
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker