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General NPI Number Information
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NPI Number | 1437344116
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Entity Type | Individual
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Provider Name | DR. SUZANNE BENNETT JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 1115 WEST CALL STREET COLLEGE OF MEDICINE FLORIDA STATE UNIVERSITY
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City | TALLAHASSEE
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State | FL
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Zip | 32306-4300
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Country | US
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Telephone | 850-644-3457
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Fax | 850-645-1773
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Provider Business Mailing Address
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Address Line | 1115 WEST CALL STREET DEPARTMENT OF MEDICAL HUMANITIES AND SOCIAL SERVICES FS
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City | TALLAHASSEE
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State | FL
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Zip | 32306-4300
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Country | US
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Telephone | 850-644-3457
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Fax | 850-645-1773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY2320
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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