Healthcare Provider Details

I. General information

NPI: 1164342572
Provider Name (Legal Business Name): TERRI JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MORGAN AVE
EAST HAVEN CT
06512-4519
US

IV. Provider business mailing address

200 MORGAN AVE
EAST HAVEN CT
06512-4519
US

V. Phone/Fax

Practice location:
  • Phone: 203-314-6979
  • Fax:
Mailing address:
  • Phone: 203-314-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: