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General NPI Number Information
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NPI Number | 1649345208
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Entity Type | Individual
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Provider Name | MATTHEW DAVID JOHNSON PHD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 4400 VESTAL PARKWAY EAST
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City | BINGHAMTON
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State | NY
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Zip | 13902-6000
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Country | US
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Telephone | 607-777-2103
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Fax | 607-777-4733
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Provider Business Mailing Address
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Address Line | BU DEPARTMENT OF PSYCHOLOGY BOX 6000
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City | BINGHAMTON
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State | NY
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Zip | 13902-6000
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Country | US
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Telephone | 607-777-6315
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Fax | 607-777-4733
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 014850
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License Number State | NY
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