Provider Demographics
NPI:1063676229
Name:JOHNSON, DEBORAH A (LIC AC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CENTRAL ST
Mailing Address - Street 2:APT. NO. 2
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5871
Mailing Address - Country:US
Mailing Address - Phone:978-777-6113
Mailing Address - Fax:
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-777-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA369171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist