1518270388 NPI number — PROF. DEBORAH SUSAN JOHNSON MS, APRN, PMHNP-BC

Table of content: PROF. DEBORAH SUSAN JOHNSON MS, APRN, PMHNP-BC (NPI 1518270388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518270388 NPI number — PROF. DEBORAH SUSAN JOHNSON MS, APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DEBORAH
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MS, APRN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518270388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 KORET WAY STE 505B
Provider Second Line Business Mailing Address:
RM 511B
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-476-4172
Provider Business Mailing Address Fax Number:
415-476-6042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
COUNSELING AND PSYCHOLOGICAL SERVICES
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94613-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-947-1740
Provider Business Practice Location Address Fax Number:
916-784-6480
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN358455 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 20650 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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