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General NPI Number Information
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NPI Number | 1528116241
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Entity Type | Individual
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Provider Name | JENNIFER ELLYN JOHNSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 935 PARK AVE #206
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City | CRANSTON
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State | RI
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Zip | 02910-2722
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Country | US
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Telephone | 401-439-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 26 JERRY LN
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-2310
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Country | US
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Telephone | 401-439-2580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS00925
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License Number State | RI
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