Provider Demographics
NPI:1386151637
Name:JOHNSON, JAMAR IZIAH (RBT, MED)
Entity type:Individual
Prefix:
First Name:JAMAR
Middle Name:IZIAH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RBT, MED
Other - Prefix:MR
Other - First Name:JAMAR
Other - Middle Name:IZIAH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:831 IRMA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3806
Mailing Address - Country:US
Mailing Address - Phone:407-796-2908
Mailing Address - Fax:
Practice Address - Street 1:831 IRMA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3806
Practice Address - Country:US
Practice Address - Phone:407-796-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-11880106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician