Individual
MATTHEW DAVID JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4400 VESTAL PARKWAY EAST, BINGHAMTON, NY 13902-6000
(607) 777-2103
(607) 777-4733
Mailing address
BU DEPARTMENT OF PSYCHOLOGY, BOX 6000, BINGHAMTON, NY 13902-6000
(607) 777-6315
(607) 777-4733
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
014850
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000135453
BLUE CROSS BLUE SHIELD OF
NY
01
—
418400
MVP INSURANCE
NY
Enumeration date
11/21/2006
Last updated
02/12/2021
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