Provider Demographics
NPI:1386814283
Name:ERIC JOHNSON
Entity Type:Organization
Organization Name:ERIC JOHNSON
Other - Org Name:FACE TO FACE CONSULTANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6179-592-7627
Mailing Address - Street 1:18 HARLOW ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2614
Mailing Address - Country:US
Mailing Address - Phone:617-592-7627
Mailing Address - Fax:617-445-2799
Practice Address - Street 1:18 HARLOW ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2614
Practice Address - Country:US
Practice Address - Phone:617-592-7627
Practice Address - Fax:617-445-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health