Provider Demographics
NPI:1275934374
Name:JOHNSON, ALEXANDER EARL
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:EARL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 KINGSTON AVE
Mailing Address - Street 2:APT 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1190
Mailing Address - Country:US
Mailing Address - Phone:904-382-0933
Mailing Address - Fax:
Practice Address - Street 1:95 KINGSTON AVE
Practice Address - Street 2:APT 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1190
Practice Address - Country:US
Practice Address - Phone:904-382-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst