Provider Demographics
NPI:1821215054
Name:JOHNSON, REBECCA S (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 FREYER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9531
Mailing Address - Country:US
Mailing Address - Phone:413-563-5288
Mailing Address - Fax:
Practice Address - Street 1:260 EASTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1213
Practice Address - Country:US
Practice Address - Phone:413-538-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health