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NPI Code Detail

MEDICARE: KEISHARA JOHNSON

MEDICARE: KEISHARA JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1932054822
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEISHARA JOHNSON
Provider Business Mailing Address
First Line : 170 MORTON ST
Second Line : MCH 12TH FLOOR
City : JAMAICA PLAIN
State : MA
Zip : 02130-3735
Country : US
Telephone Number :
Fax Number : 617-830-8796
Provider Business Practice Location Address
First Line : 170 MORTON ST
Second Line : MCH 12TH FLOOR
City : JAMAICA PLAIN
State : MA
Zip : 02130-3735
Country : US
Telephone Number : 617-318-5620
Fax Number : 617-830-8796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ KEISHARA JOHNSON ” Practice Location

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