MEDICARE: MS. JAYNE D JOHNSON MED, CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1246	FL
2	101YP2500X	Professional Counselor	1246	FL
3	103K00000X	Behavior Analyst	1246	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1246	OTHER	FL	CERTIFIED ADDICTIONS PROFESSIONAL

General Provider Information

NPI Number	:	1245531797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAYNE D JOHNSON MED, CAP

Provider Business Mailing Address
First Line	:	4200 N OCEAN DR
Second Line	:	SUITE 301-1
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-2856
Country	:	US
Telephone Number	:	561-841-7789
Fax Number	:	561-841-7789

Provider Business Practice Location Address
First Line	:	4200 N OCEAN DR
Second Line	:	SUITE 301-1
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-2856
Country	:	US
Telephone Number	:	561-841-7789
Fax Number	:	561-841-7789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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