Healthcare Provider Details

I. General information

NPI: 1326101536
Provider Name (Legal Business Name): MARY JO JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JO RIOUX

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 CROW CANYON RD STE 202
SAN RAMON CA
94583-1659
US

IV. Provider business mailing address

150 EMERALD DR
DANVILLE CA
94526-2450
US

V. Phone/Fax

Practice location:
  • Phone: 925-722-6225
  • Fax:
Mailing address:
  • Phone: 248-207-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW138149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: