Healthcare Provider Details

I. General information

NPI: 1285339986
Provider Name (Legal Business Name): LISA ELIZABETH JOHNSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1043
SAN FRANCISCO CA
94102-1301
US

IV. Provider business mailing address

490 POST ST STE 1043
SAN FRANCISCO CA
94102-1301
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number18099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: