Doctor Name: | KIMBERLY A JOHNSON |
NPI Number: | 1033413604 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 26908 |
Business Practice Address: | 1760 W 16th St San Bernardino, CA - 924111160 |
Business Phone Number: | 9094731200 |
Business Fax Number: | |
Mailing Address: | Po Box 1406, GUASTI |
State: | CA |
Postal Code: | 917431406 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/22/2010 |
NPI Last Update Date: | 12/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 26908 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |