=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558388298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHNSTON PSYCHOLOGY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 01/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 ALLENS CREEK RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-427-7800
-----------------------------------------------------
Fax | 585-427-7817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 ALLENS CREEK RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-427-7800
-----------------------------------------------------
Fax | 585-427-7817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FRANK CALVIN JOHNSTON II
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 585-427-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 9362
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 8704
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------