=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881024925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRIET JOHNSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2013
-----------------------------------------------------
Last Update Date | 01/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 772 ESTERBROOK CT APT A
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-3484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-307-1685
-----------------------------------------------------
Fax | 510-307-1615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 772 ESTERBROOK CT APT A
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-3484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-307-1685
-----------------------------------------------------
Fax | 510-307-1615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801061974
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS28773
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------