Provider Demographics
NPI:1518270388
Name:JOHNSON, DEBORAH SUSAN (MS, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:PROF
First Name:DEBORAH
Middle Name:SUSAN
Last Name:JOHNSON
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Gender:F
Credentials:MS, APRN, PMHNP-BC
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Mailing Address - Street 1:2 KORET WAY STE 505B
Mailing Address - Street 2:RM 511B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0608
Mailing Address - Country:US
Mailing Address - Phone:415-476-4172
Mailing Address - Fax:415-476-6042
Practice Address - Street 1:5000 MACARTHUR BLVD
Practice Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94613-1301
Practice Address - Country:US
Practice Address - Phone:916-947-1740
Practice Address - Fax:916-784-6480
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2017-02-22
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Provider Licenses
StateLicense IDTaxonomies
CARN358455163W00000X
CA20650363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse