Provider Demographics
NPI:1174063804
Name:JOHNSTON, MARTIN (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1704
Mailing Address - Country:US
Mailing Address - Phone:401-846-1030
Mailing Address - Fax:
Practice Address - Street 1:117 BELLEVUE AVE
Practice Address - Street 2:SUITE 201B
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-7439
Practice Address - Country:US
Practice Address - Phone:401-846-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical