Provider Demographics
NPI:1720394034
Name:JOHNSON, PAUL E JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04757-4501
Mailing Address - Country:US
Mailing Address - Phone:207-318-8570
Mailing Address - Fax:
Practice Address - Street 1:1389 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:ME
Practice Address - Zip Code:04757-4501
Practice Address - Country:US
Practice Address - Phone:207-318-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool