Healthcare Provider Details

I. General information

NPI: 1427207018
Provider Name (Legal Business Name): SHARON LORRAINE JOHNSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E. HERNDON AVE. SUITE #306
FRESNO CA
93720-3100
US

IV. Provider business mailing address

1111 E HERNDON AVE SUITE #306
FRESNO CA
93720-3100
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-0112
  • Fax: 559-440-0114
Mailing address:
  • Phone: 559-440-0112
  • Fax: 559-440-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY12494
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: