Provider Demographics
NPI:1447122569
Name:LOURENCO, JOHNNA KATELYN
Entity type:Individual
Prefix:MISS
First Name:JOHNNA
Middle Name:KATELYN
Last Name:LOURENCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3331
Mailing Address - Country:US
Mailing Address - Phone:401-473-9765
Mailing Address - Fax:
Practice Address - Street 1:819 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1815
Practice Address - Country:US
Practice Address - Phone:401-268-4007
Practice Address - Fax:888-972-3966
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00304-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health