Provider Demographics
NPI:1891024212
Name:JOHNSON-MARKVE, BENJAMIN LUKE (PSYD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
Last Name:JOHNSON-MARKVE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 LEE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2262
Mailing Address - Country:US
Mailing Address - Phone:407-303-7991
Mailing Address - Fax:
Practice Address - Street 1:1685 LEE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2262
Practice Address - Country:US
Practice Address - Phone:407-303-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8027103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist