Provider Demographics
NPI:1114263142
Name:JOHNSON, CLARE EILEEN (MA, MFT)
Entity Type:Individual
Prefix:MISS
First Name:CLARE
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:EILEEN
Other - Last Name:WEIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1630 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3007
Mailing Address - Country:US
Mailing Address - Phone:415-255-3357
Mailing Address - Fax:
Practice Address - Street 1:1630 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3007
Practice Address - Country:US
Practice Address - Phone:415-255-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist