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General NPI Number Information
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NPI Number | 1023783248
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Entity Type | Individual
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Provider Name | JENNIFER JOHNSON PHD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 2535 CAMINO DEL RIO S STE 303
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City | SAN DIEGO
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State | CA
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Zip | 92108-3757
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Country | US
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Telephone | 301-836-1939
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Fax |
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Provider Business Mailing Address
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Address Line | 2535 CAMINO DEL RIO S STE 303
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City | SAN DIEGO
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State | CA
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Zip | 92108-3757
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Country | US
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Telephone | 301-836-1939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06529
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License Number State | MD
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