Provider Demographics
NPI:1437344116
Name:JOHNSON, SUZANNE BENNETT
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:BENNETT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEST CALL STREET
Mailing Address - Street 2:DEPARTMENT OF MEDICAL HUMANITIES AND SOCIAL SERVICES FS
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4300
Mailing Address - Country:US
Mailing Address - Phone:850-644-3457
Mailing Address - Fax:850-645-1773
Practice Address - Street 1:1115 WEST CALL STREET
Practice Address - Street 2:COLLEGE OF MEDICINE FLORIDA STATE UNIVERSITY
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4300
Practice Address - Country:US
Practice Address - Phone:850-644-3457
Practice Address - Fax:850-645-1773
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2320103T00000X
103TC2200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth