Provider Demographics
NPI:1477743615
Name:JOHNSTON, ELIZABETH ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5854
Mailing Address - Country:US
Mailing Address - Phone:603-526-7466
Mailing Address - Fax:
Practice Address - Street 1:THE GALLERY, 276 NEWPORT RD.
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:603-526-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical