Provider Demographics
NPI:1669563698
Name:JOHNSON, ELIZABETH J (MS, MFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 CARRS POND ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-378-8422
Mailing Address - Fax:401-784-3636
Practice Address - Street 1:456 CARRS POND ROAD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-378-8422
Practice Address - Fax:401-784-3636
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30948OtherBLUE CROSS