Matthew David Johnson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

014850 Issued in NY

Practice address

4400 Vestal Parkway East
Binghamton, NY 13902-6000

Phone

(607) 777-2103

Fax

(607) 777-4733

NPI assigned

Nov 21, 2006

Last updated

Feb 12, 2021By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Binghamton University

  • Primary Care Clinic/Center
  • Binghamton, NY
  • NPI 1558901173
  NPD
• Binghamton University Health Services

  • Student Health Clinic/Center
  • Binghamton, NY
  • NPI 1568679520
  NPD (past)
• Children's Unit for Treatment and Evaluation

  • Early Intervention Provider Agency
  • Binghamton, NY
  • NPI 1053565184
  NPD (past)
• The Research Foundation for Suny at Binghamton

  • Early Intervention Provider Agency
  • Vestal, NY
  • NPI 1285070516
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1649345208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BU DEPARTMENT OF PSYCHOLOGY",
            "address_2": "BOX 6000",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139026000",
            "telephone_number": "607-777-6315",
            "fax_number": "607-777-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 VESTAL PARKWAY EAST",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139026000",
            "telephone_number": "607-777-2103",
            "fax_number": "607-777-4733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "000135453",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP INSURANCE",
            "identifier": "418400",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily McLean Johnson
• Justine Johnson
• Karen Alice Johnson, R.N.
• Kayla Paige Johnson, LCSW
• Maryellen Johnson, CNM
• Nicole Johnson
• Portia Johnson, NP
• Sylvia M Johnson
• Tamara A. Johnson, MS, CCC/SLP
• Yvette Michael Johnson, LCSW

• Clinical Psychologist in Binghamton, NY
• Providers in Binghamton, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.