=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356577530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL S. JOHNSON, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2009
-----------------------------------------------------
Last Update Date | 06/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 NORTH ST SUITE 316
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-748-8515
-----------------------------------------------------
Fax | 845-225-3939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 NORTH ST SUITE 316
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-748-8515
-----------------------------------------------------
Fax | 845-225-3939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST - PRERSIDENT
-----------------------------------------------------
Name | DR. MICHAEL SCOTT JOHNSON
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 203-748-8515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------