Healthcare Provider Details

I. General information

NPI: 1467576868
Provider Name (Legal Business Name): NICHOLAS BEECHING JOHNSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 WALNUT STREET
BROOKLINE MA
02445-6710
US

IV. Provider business mailing address

162 WALNUT STREET
BROOKLINE MA
02445-6710
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-7151
  • Fax: 617-738-0977
Mailing address:
  • Phone: 617-232-7151
  • Fax: 617-738-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1544
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: