Provider Demographics
NPI:1629842398
Name:JOHNSTON, SHADI (LMHC)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HOMER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6976
Mailing Address - Country:US
Mailing Address - Phone:617-947-2262
Mailing Address - Fax:
Practice Address - Street 1:22 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4972
Practice Address - Country:US
Practice Address - Phone:617-396-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health