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Individual

MR. GEORDAN LEGETTE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
504 DUDLEY ST, ROXBURY, MA 02119-2732
(617) 445-6655
Mailing address
175 WOODROW AVE, DORCHESTER CENTER, MA 02124-3210
(617) 388-8139

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
S66991897
MA

Other

Enumeration date
10/15/2010
Last updated
10/15/2010
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