Healthcare Provider Details

I. General information

NPI: 1881024925
Provider Name (Legal Business Name): HARRIET JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 ESTERBROOK CT APT A
ALAMEDA CA
94501-3484
US

IV. Provider business mailing address

772 ESTERBROOK CT APT A
ALAMEDA CA
94501-3484
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-1685
  • Fax: 510-307-1615
Mailing address:
  • Phone: 510-307-1685
  • Fax: 510-307-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061974
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS28773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: