Provider Demographics
NPI:1417265133
Name:JOHNSON, ROBIN J
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
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 1:3 LEPINE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-3244
Mailing Address - Country:US
Mailing Address - Phone:508-277-4830
Mailing Address - Fax:
Practice Address - Street 1:3 LEPINE DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-3244
Practice Address - Country:US
Practice Address - Phone:508-317-2323
Practice Address - Fax:508-519-5619
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8333101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health