Provider Demographics
NPI:1033983580
Name:JOHNSON, JEANA ROSE (LMHC)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FRENCH ST # 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2347
Mailing Address - Country:US
Mailing Address - Phone:857-600-6223
Mailing Address - Fax:
Practice Address - Street 1:16 FRENCH ST # 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2347
Practice Address - Country:US
Practice Address - Phone:857-600-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12508-MH-CC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor