Provider Demographics
NPI:1780928556
Name:JOHNSON, JERROD K (PSYD)
Entity type:Individual
Prefix:
First Name:JERROD
Middle Name:K
Last Name:JOHNSON
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 1:1881 N UNIVERSITY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6093
Mailing Address - Country:US
Mailing Address - Phone:954-340-0888
Mailing Address - Fax:954-954-3460
Practice Address - Street 1:1881 N UNIVERSITY DR STE 104
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6093
Practice Address - Country:US
Practice Address - Phone:954-340-0888
Practice Address - Fax:954-346-0909
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003599103TC0700X
FLPY8744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical