Provider Demographics
NPI:1780920215
Name:JOHNSTON, DONNA (MSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239
Mailing Address - Country:US
Mailing Address - Phone:860-774-2015
Mailing Address - Fax:
Practice Address - Street 1:70 COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239
Practice Address - Country:US
Practice Address - Phone:860-774-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0090501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker