Provider Demographics
NPI:1043694136
Name:JOHNSON-HASAN, RONNISHIA (LCSW)
Entity Type:Individual
Prefix:
First Name:RONNISHIA
Middle Name:
Last Name:JOHNSON-HASAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 BANCROFT AVE APT 233
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2697
Mailing Address - Country:US
Mailing Address - Phone:415-822-1707
Mailing Address - Fax:415-822-1723
Practice Address - Street 1:1728 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2697
Practice Address - Country:US
Practice Address - Phone:415-822-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA72607101Y00000X
CA1063741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor