Provider Demographics
NPI:1487677589
Name:JOHNSON, JULIUS MAURICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:MAURICE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 GEARY BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3357
Mailing Address - Country:US
Mailing Address - Phone:415-905-4557
Mailing Address - Fax:415-386-4512
Practice Address - Street 1:3410 GEARY BLVD STE 328
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3357
Practice Address - Country:US
Practice Address - Phone:415-905-4557
Practice Address - Fax:415-386-4512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5552813Medicaid
CA00PL88210Medicare UPIN