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Individual

MATTHEW B JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
B.S.

Contact information

Practice address
319 E WATER ST, SYRACUSE, NY 13202-1123
(315) 475-1771
Mailing address
2094 KYPRIOTIS DR, CORTLAND, NY 13045-9538

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
271578278
NY
Enumeration date
11/01/2022
Last updated
11/01/2022
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