Healthcare Provider Details

I. General information

NPI: 1265423396
Provider Name (Legal Business Name): MS. JOAN SHARON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTH ST
NEW HAVEN VT
05472-2003
US

IV. Provider business mailing address

30 NORTH ST
NEW HAVEN VT
05472-2003
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-7912
  • Fax:
Mailing address:
  • Phone: 802-453-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0680000272
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: