Provider Demographics
NPI:1639190119
Name:JOHNSTON, SUSAN LEFFERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEFFERT
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:HOPE
Other - Last Name:LEFFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1608
Mailing Address - Country:US
Mailing Address - Phone:585-427-7800
Mailing Address - Fax:585-427-7817
Practice Address - Street 1:480 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1608
Practice Address - Country:US
Practice Address - Phone:585-427-7800
Practice Address - Fax:585-427-7817
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR55025Medicare UPIN
NYBB9565Medicare ID - Type Unspecified