Provider Demographics
NPI:1518174176
Name:JOHNSON, DONALD JEFFERY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JEFFERY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 CASTELLO DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8982
Mailing Address - Country:US
Mailing Address - Phone:239-262-1880
Mailing Address - Fax:239-262-1880
Practice Address - Street 1:5051 CASTELLO DR
Practice Address - Street 2:SUITE 213
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8982
Practice Address - Country:US
Practice Address - Phone:239-262-1880
Practice Address - Fax:239-262-1880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4853103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist