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NPI Code Detail

MEDICARE: MS. BRIDIE MAE JOHNSON LCSW

MEDICARE: MS. BRIDIE MAE JOHNSON 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
1101YA0400XAddiction (Substance Use Disorder) CounselorC-03921MI
21041C0700XClinical Social Worker6801080144MI
3104100000XSocial Worker120229CA
4374J00000XDoulaMI-02985MI
5101YA0400XAddiction (Substance Use Disorder) CounselorS-03921MI
61041C0700XClinical Social WorkerCSW.09927483CO
71041C0700XClinical Social Worker120229CA

General Provider Information

NPI Number : 1447642566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRIDIE MAE JOHNSON LCSW
Provider Business Mailing Address
First Line : 1919 ADDISON ST STE 204
Second Line :
City : BERKELEY
State : CA
Zip : 94704-1143
Country : US
Telephone Number : 510-899-7445
Fax Number :
Provider Business Practice Location Address
First Line : 1605 JEFFERSON ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1215
Country : US
Telephone Number : 510-923-1099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2015
Last Update Date : 10/21/2025

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