Healthcare Provider Details

I. General information

NPI: 1528031119
Provider Name (Legal Business Name): CYNTHIA R JOHNSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

PO BOX 100165
GAINESVILLE FL
32610-0165
US

V. Phone/Fax

Practice location:
  • Phone: 216-448-6440
  • Fax:
Mailing address:
  • Phone: 352-273-6617
  • Fax: 352-273-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPS006135L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: