Provider Demographics
NPI:1588195747
Name:JOHNSON, ROBERT EMERSON LAMB III (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EMERSON LAMB
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 GULF ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6535
Mailing Address - Country:US
Mailing Address - Phone:203-252-0667
Mailing Address - Fax:
Practice Address - Street 1:58 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3381
Practice Address - Country:US
Practice Address - Phone:203-252-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist