Healthcare Provider Details

I. General information

NPI: 1366881534
Provider Name (Legal Business Name): ANDREA MARIE JOHNSTONE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD SUITE 530
WARWICK RI
02886-1617
US

IV. Provider business mailing address

10 CASEY LN
COVENTRY RI
02816-5042
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01425
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPST00168
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: