Provider Demographics
NPI:1609915750
Name:JOHNSON, CRAIG ELLIOTT (MSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ELLIOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 FULTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5108
Mailing Address - Country:US
Mailing Address - Phone:916-482-7058
Mailing Address - Fax:916-481-2230
Practice Address - Street 1:2740 FULTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5108
Practice Address - Country:US
Practice Address - Phone:916-482-7058
Practice Address - Fax:916-481-2230
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW19411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ88702ZMedicare ID - Type Unspecified