MEDICARE: JOHANNA MAUREEN CRESPIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	122373	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122373	OTHER	CA	LCSW

General Provider Information

NPI Number	:	1215556022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA MAUREEN CRESPIN LCSW

Provider Business Mailing Address
First Line	:	1026 HAZEN DR
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2009
Country	:	US
Telephone Number	:	570-902-9217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 202
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3760
Country	:	US
Telephone Number	:	714-253-4429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2020
Last Update Date	:	05/08/2024

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