Provider Demographics
NPI:1033932769
Name:JOHNSON, MERRI LEE (AAMA)
Entity type:Individual
Prefix:
First Name:MERRI LEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:N. CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1367
Mailing Address - Country:US
Mailing Address - Phone:508-517-1406
Mailing Address - Fax:
Practice Address - Street 1:809 WELLMAN AVE
Practice Address - Street 2:
Practice Address - City:N. CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1367
Practice Address - Country:US
Practice Address - Phone:508-517-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IL297156251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator