Basic Information
| Provider Information | |||||||||
| NPI: | 1255549176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHANSSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | CLAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 GODEN ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024782925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179321911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100A HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786825276 | ||||||||
| FaxNumber: | 9786884932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 157343 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.