Provider Demographics
NPI:1902021017
Name:JOHNSON, MARGO
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2918
Mailing Address - Country:US
Mailing Address - Phone:415-292-1555
Mailing Address - Fax:415-292-2030
Practice Address - Street 1:1700 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2918
Practice Address - Country:US
Practice Address - Phone:415-292-1555
Practice Address - Fax:415-292-2030
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1034OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
1034OtherSFGH INTERNAL USE ONLY