Provider Demographics
NPI:1235514605
Name:HARRINGTON, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MACE BLVD
Mailing Address - Street 2:SUITE J #114
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6053
Mailing Address - Country:US
Mailing Address - Phone:530-574-0556
Mailing Address - Fax:
Practice Address - Street 1:417 MACE BLVD
Practice Address - Street 2:SUITE J #114
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6053
Practice Address - Country:US
Practice Address - Phone:530-574-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18112103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12385575OtherCAQH NUMBER
CA13678883OtherCAQH