Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 7850 | FL |
Y | 103TC0700X | Clinical Psychologist | 7850 | FL |
N | 103G00000X | Clinical Psychologist | 7850 | FL |
N | 103TC0700X | Clinical Psychologist | 7850 | FL |
N | 103TR0400X | Rehabilitation Psychologist | 7850 | FL |
NPI | 1700827334 |
---|---|
Provider Name | Dr. Douglas Johnson-Greene |
First Address | Miami, FL 33136-2107 |
Second Address | Miami, FL 33136-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DA144Z | (02) | FL |