Provider Demographics
NPI:1558388298
Name:JOHNSTON PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:JOHNSTON PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-427-7800
Mailing Address - Street 1:160 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3309
Mailing Address - Country:US
Mailing Address - Phone:585-427-7800
Mailing Address - Fax:585-427-7817
Practice Address - Street 1:160 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3309
Practice Address - Country:US
Practice Address - Phone:585-427-7800
Practice Address - Fax:585-427-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8704103T00000X
NY9362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR54959Medicare UPIN
NYBB9564Medicare ID - Type Unspecified
NYBB9565Medicare ID - Type Unspecified
NYR55025Medicare UPIN