Provider Demographics
NPI:1972659274
Name:JOHNSON, SARAH EMILY (LIC AC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:EMILY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LIC AC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BERKSHIRE ST
Mailing Address - Street 2:APT 6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1447
Mailing Address - Country:US
Mailing Address - Phone:617-308-6620
Mailing Address - Fax:
Practice Address - Street 1:44 PEARL ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4041
Practice Address - Country:US
Practice Address - Phone:617-308-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226534171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist