Provider Demographics
NPI:1730319831
Name:JOHNSON, CLIFFORD JERON (MS)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:JERON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 THESY DR
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6837
Mailing Address - Country:US
Mailing Address - Phone:321-254-5927
Mailing Address - Fax:321-254-5927
Practice Address - Street 1:1037 PATHFINDER WAY
Practice Address - Street 2:SUITE130
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3242
Practice Address - Country:US
Practice Address - Phone:321-639-1224
Practice Address - Fax:321-636-0800
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health