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General NPI Number Information
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NPI Number | 1447642566
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Entity Type | Individual
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Provider Name | BRIDIE MAE JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1605 JEFFERSON ST
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City | OAKLAND
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State | CA
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Zip | 94612-1215
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Country | US
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Telephone | 510-923-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 ADDISON ST STE 204
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City | BERKELEY
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State | CA
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Zip | 94704-1143
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Country | US
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Telephone | 510-899-7445
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-03921
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801080144
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 120229
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number | MI-02985
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | S-03921
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09927483
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License Number State | CO
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 120229
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License Number State | CA
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