Provider Demographics
NPI:1417329384
Name:JOHNSON, ALICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 PIEDMONT AVE # 185
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5221
Mailing Address - Country:US
Mailing Address - Phone:510-982-1000
Mailing Address - Fax:
Practice Address - Street 1:2961 SUMMIT ST STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3482
Practice Address - Country:US
Practice Address - Phone:510-982-1000
Practice Address - Fax:510-210-9310
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAPSY33151103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program