Healthcare Provider Details

I. General information

NPI: 1629218193
Provider Name (Legal Business Name): NICHOLAS STEINY JOHNSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CUMBERLAND ST SUITE 102
WOONSOCKET RI
02895-3300
US

IV. Provider business mailing address

68 CUMBERLAND ST SUITE 102
WOONSOCKET RI
02895-3300
US

V. Phone/Fax

Practice location:
  • Phone: 401-356-1940
  • Fax: 401-356-1949
Mailing address:
  • Phone: 401-356-1940
  • Fax: 401-356-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01250
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: