Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1023675675 |
---|---|
Provider Name | Courteney Johnson |
First Address | Bronx, NY 10460-2222 |
Second Address | Bronx, NY 10460-2222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2019 |
Last Update Date | 20/05/2019 |