| Doctor Name: | EMILY JOHNSON |
| NPI Number: | 1013288331 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PY8420 |
| Business Practice Address: | 1540 International Pkwy Suite 2000 Lake Mary, FL - 327464713 |
| Business Phone Number: | 4075365383 |
| Business Fax Number: | 4075365301 |
| Mailing Address: | 1540 International Pkwy, Suite 2000 LAKE MARY |
| State: | FL |
| Postal Code: | 327464713 |
| Phone Number: | 4075365383 |
| Fax Number: | 4075365301 |
| NPI Enumeration Date: | 01/18/2012 |
| NPI Last Update Date: | 01/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY8420 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |