Doctor Name: | MS. GERALYN ELIZABETH JOHNSON |
NPI Number: | 1154625630 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 4571 |
Business Practice Address: | 491 Main St Athol, MA - 013311846 |
Business Phone Number: | 9782499490 |
Business Fax Number: | 9782499514 |
Mailing Address: | 491 Main St, ATHOL |
State: | MA |
Postal Code: | 013311846 |
Phone Number: | 9782499490 |
Fax Number: | 9782499514 |
NPI Enumeration Date: | 12/27/2010 |
NPI Last Update Date: | 12/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4571 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |