Provider Demographics
NPI:1407158934
Name:JOHNSON, CINDY RAE (CRP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CENTER ST # 511
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6000
Mailing Address - Country:US
Mailing Address - Phone:207-513-0214
Mailing Address - Fax:
Practice Address - Street 1:120 CENTER ST # 511
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6000
Practice Address - Country:US
Practice Address - Phone:207-513-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435089000Medicaid