Provider Demographics
NPI:1346594272
Name:JOHNSON, CARMEN (BA, LMT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5336
Mailing Address - Country:US
Mailing Address - Phone:978-973-3009
Mailing Address - Fax:
Practice Address - Street 1:246 MAIN ST
Practice Address - Street 2:UNIT #4
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1371
Practice Address - Country:US
Practice Address - Phone:978-973-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT5738225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5738OtherMT