Provider Demographics
NPI:1235112137
Name:JOHNSTON, MARIE G (RN, LADC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:G
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-2111
Mailing Address - Country:US
Mailing Address - Phone:860-274-5925
Mailing Address - Fax:
Practice Address - Street 1:88 GRANDVIEW AVE
Practice Address - Street 2:WESTMAIN BEHAVIORAL HEALTH
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2509
Practice Address - Country:US
Practice Address - Phone:203-573-7500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000399101YA0400X
CTE31451163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)