Provider Demographics
NPI:1467854471
Name:JOHANSSON, KRISTINA I
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JOHANSSON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BREWSTER CT
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3801
Mailing Address - Country:US
Mailing Address - Phone:413-587-3265
Mailing Address - Fax:413-587-3268
Practice Address - Street 1:17 BREWSTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3801
Practice Address - Country:US
Practice Address - Phone:413-587-3265
Practice Address - Fax:413-587-3268
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health