Provider Demographics
NPI:1720250202
Name:SABIN, JOHANNA M (PSY, D)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:M
Last Name:SABIN
Suffix:
Gender:F
Credentials:PSY, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WEBSTER AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3336
Mailing Address - Country:US
Mailing Address - Phone:617-480-1911
Mailing Address - Fax:
Practice Address - Street 1:25 WEBSTER AVE APT 204
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3336
Practice Address - Country:US
Practice Address - Phone:617-480-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical