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NPI Code Detail

MEDICARE: DR. STEPHANIE JOHNSON PSY.D.

MEDICARE: DR. STEPHANIE JOHNSON PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist23722CA

General Provider Information

NPI Number : 1962564450
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE JOHNSON PSY.D.
Provider Business Mailing Address
First Line : 5440 HARCROSS DRIVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 10458-2636
Country : US
Telephone Number : 646-763-1072
Fax Number :
Provider Business Practice Location Address
First Line : 1605 EASTLAKE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1009
Country : US
Telephone Number : 323-226-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 06/16/2018

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