Geordan Legette Johnson

Primary specialty

PsychologistTaxonomy code 103T00000X

License

S66991897 Issued in MA

Practice address

504 Dudley St
Roxbury, MA 02119-2732

Phone

(617) 445-6655

NPI assigned

Oct 15, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Services of Roxbury

  • Mental Health Counselor
  • Roxbury, MA
  • NPI 1669107678
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1194035774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 WOODROW AVE",
            "city": "DORCHESTER CENTER",
            "state": "MA",
            "postal_code": "021243210",
            "telephone_number": "617-388-8139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 DUDLEY ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021192732",
            "telephone_number": "617-445-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GEORDAN",
        "middle_name": "LEGETTE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "S66991897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rashida S Jenkins, NP
• Aaliyah Jennings
• Jocelyne Jezzini, B.D.S., C.A.G.S.
• Aquedo Jimenez Jr.
• Elsa Jimenez, MSW
• Jasmine Johnson
• Jessica Johnson
• Karen Johnson
• Wedman Jonathas
• Amara Knay Jones Reeves

• Psychologist in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.