Provider Demographics
NPI:1578939005
Name:JOHANSON, CAROLINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 PITTSTON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2964
Mailing Address - Country:US
Mailing Address - Phone:570-209-9898
Mailing Address - Fax:
Practice Address - Street 1:3218 PITTSTON AVE STE 8
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2964
Practice Address - Country:US
Practice Address - Phone:570-209-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist