Provider Demographics
NPI:1043517634
Name:JOHNSON, KATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1221
Mailing Address - Country:US
Mailing Address - Phone:617-923-7575
Mailing Address - Fax:617-663-6252
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4411
Practice Address - Country:US
Practice Address - Phone:617-923-7575
Practice Address - Fax:617-663-6252
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst