| Doctor Name: | CARISSA JULIA JOHNSON |
| NPI Number: | 1053665117 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.A. |
| License Number: | |
| Business Practice Address: | 80 Erdman Way Suite 208 Leominster, MA - 014531840 |
| Business Phone Number: | 4015699838 |
| Business Fax Number: | |
| Mailing Address: | 80 Erdman Way, Suite 208 LEOMINSTER |
| State: | MA |
| Postal Code: | 014531840 |
| Phone Number: | 4015699838 |
| Fax Number: | |
| NPI Enumeration Date: | 10/28/2012 |
| NPI Last Update Date: | 10/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |