=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235112137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE G. JOHNSTON R.N., L.A.D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88 GRANDVIEW AVE WESTMAIN BEHAVIORAL HEALTH
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-573-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 SUNSET AVE
-----------------------------------------------------
City | OAKVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06779-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-274-5925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 000399
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
-----------------------------------------------------
License Number | E31451
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------