Provider Demographics
NPI:1558335067
Name:JOHNSON, ALISON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
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 1:1297 E CALAVERAS ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2535
Mailing Address - Country:US
Mailing Address - Phone:818-421-5421
Mailing Address - Fax:
Practice Address - Street 1:867 ATCHISON ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2314
Practice Address - Country:US
Practice Address - Phone:626-798-0915
Practice Address - Fax:626-798-1850
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18416Medicare UPIN