Active NPI
Cynthia Teener Johnson, PH.D.
- Psychologist
- Boulder, CO
National Provider Identifier
1447748330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY.0004649
- Practice address
- 3405 Penrose PL Ste 203
Boulder, CO 80301-1820 - Phone
- (720) 617-9800
- NPI assigned
- Apr 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY.0004649 | CO | Primary |
Addresses
Primary practice location
3405 Penrose PL Ste 203
Boulder, CO 80301-1820
Mailing address
3313 Sentinel Dr
Boulder, CO 80301-5451
Phone (303) 810-0307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0004649 | CO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1447748330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3313 SENTINEL DR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803015451",
"telephone_number": "303-810-0307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3405 PENROSE PL STE 203",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011820",
"telephone_number": "720-617-9800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CYNTHIA",
"middle_name": "TEENER",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-25",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "PSY.0004649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.