Healthcare Provider Details

I. General information

NPI: 1326464165
Provider Name (Legal Business Name): JOHANNA M KOLODZIEJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 NORTHAMPTON ST STE 26
EASTHAMPTON MA
01027-1054
US

IV. Provider business mailing address

247 NORTHAMPTON ST STE 26
EASTHAMPTON MA
01027-1054
US

V. Phone/Fax

Practice location:
  • Phone: 413-343-7317
  • Fax: 413-343-7318
Mailing address:
  • Phone: 413-343-7317
  • Fax: 413-343-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN232481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: