Jackie Johnson, PSYCHOLOGY INTERN

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

111 South St.
Somerville, MA 02143

Phone

(617) 284-5130

NPI assigned

Oct 15, 2010

Last updated

Oct 15, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Community Care, Inc.

  • Community/Behavioral Health Agency
  • Norwood, MA
  • NPI 1780791467
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1407166119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SOUTH ST.",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "02143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SOUTH ST.",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "02143",
            "telephone_number": "617-284-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACKIE",
        "name_prefix": "Ms.",
        "credential": "PSYCHOLOGY INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Jeudy
• John J. Ambarik DDS, PC
• Julia Johns, MS CCC-SLP
• Evelyn Johnson
• Gregory A. Johnson, MD
• Julia Bowie Johnson, MSW
• Lisa Marie Johnson, LCSW
• Margaret Sarah Johnson
• Peter L Johnson, LICSW
• Renee Christine Johnson, RN

• Student in an Organized Health Care Education/Training Program in Somerville, MA
• Providers in Somerville, MA by specialty
• Student in an Organized Health Care Education/Training Program in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.