Healthcare Provider Details

I. General information

NPI: 1992916134
Provider Name (Legal Business Name): CYNTHIA L JOHNSON-GEORGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 03/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 E CALIFORNIA BLVD
PASADENA CA
91106-3847
US

IV. Provider business mailing address

685 E CALIFORNIA BLVD
PASADENA CA
91106-3847
US

V. Phone/Fax

Practice location:
  • Phone: 626-244-7723
  • Fax:
Mailing address:
  • Phone: 626-244-7723
  • Fax: 703-356-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810000964
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: