Provider Demographics
NPI:1952762726
Name:JOHNSON, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SCOTLAND YARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5913
Mailing Address - Country:US
Mailing Address - Phone:904-305-2069
Mailing Address - Fax:904-342-1430
Practice Address - Street 1:165 SCOTLAND YARD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-5913
Practice Address - Country:US
Practice Address - Phone:904-305-2069
Practice Address - Fax:904-342-1430
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst