Provider Demographics
NPI:1083908594
Name:JOHNSON, ULRIC R (LMHC, LMFT, RC, PHD)
Entity Type:Individual
Prefix:
First Name:ULRIC
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC, LMFT, RC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3507
Mailing Address - Country:US
Mailing Address - Phone:617-365-0637
Mailing Address - Fax:
Practice Address - Street 1:2 MOODY ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3507
Practice Address - Country:US
Practice Address - Phone:617-365-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40101YA0400X
MA265101YM0800X
MA149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist