Healthcare Provider Details

I. General information

NPI: 1447642566
Provider Name (Legal Business Name): BRIDIE MAE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 JEFFERSON ST
OAKLAND CA
94612-1215
US

IV. Provider business mailing address

1919 ADDISON ST STE 204
BERKELEY CA
94704-1143
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-1099
  • Fax:
Mailing address:
  • Phone: 510-899-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-03921
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080144
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120229
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberMI-02985
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberS-03921
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09927483
License Number StateCO
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: