Individual
DR. KEITH PHILLIP JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
240 E 38TH ST FL 15, NEW YORK, NY 10016-2708
(212) 263-6037
Mailing address
240 E 38TH ST FL 15, NEW YORK, NY 10016-2708
(212) 263-6037
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
025658
NY
103T00000X
Psychologist
025658
NY
103TH0004X
Health Psychologist
025658
NY
103TR0400X
Rehabilitation Psychologist
025658
NY
Other
Enumeration date
05/01/2023
Last updated
05/13/2023
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