Healthcare Provider Details

I. General information

NPI: 1285322586
Provider Name (Legal Business Name): CHRISTOPHER JOHNSON MA PSY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N PLANK RD STE 10
NEWBURGH NY
12550-2111
US

IV. Provider business mailing address

17 N PLANK RD STE 10
NEWBURGH NY
12550-2111
US

V. Phone/Fax

Practice location:
  • Phone: 646-320-1997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: