Provider Demographics
NPI:1245531797
Name:JOHNSON, JAYNE D (MED, CAP)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 N OCEAN DR
Mailing Address - Street 2:SUITE 301-1
Mailing Address - City:SINGER ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33404-2856
Mailing Address - Country:US
Mailing Address - Phone:561-841-7789
Mailing Address - Fax:561-841-7789
Practice Address - Street 1:4200 N OCEAN DR
Practice Address - Street 2:SUITE 301-1
Practice Address - City:SINGER ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33404-2856
Practice Address - Country:US
Practice Address - Phone:561-841-7789
Practice Address - Fax:561-841-7789
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1246101YA0400X, 101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1246OtherCERTIFIED ADDICTIONS PROFESSIONAL