Provider Demographics
NPI:1477331882
Name:JOHNSON, CRYSTAL LACHEA (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LACHEA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3211
Mailing Address - Country:US
Mailing Address - Phone:203-907-9665
Mailing Address - Fax:
Practice Address - Street 1:1 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2717
Practice Address - Country:US
Practice Address - Phone:203-463-4555
Practice Address - Fax:203-517-0058
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12398363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health