Individual
RUTH E JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, CNM, CS
Contact information
Practice address
42 WASHINGTON ST, SUITE 210, WELLESLEY, MA 02481-1803
(781) 431-2629
Mailing address
20 WILBUR AVE, ARLINGTON, MA 02476-7128
(781) 643-1263
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
196057
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55001005881
PACIFICARE PROVIDER NUMBE
MA
01
—
7902642
AETNA PROVIDER NUMBER
MA
01
—
PN0768
BCBSMA PROVIDER NUMBER
MA
Enumeration date
01/06/2007
Last updated
07/08/2007
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