Provider Demographics
NPI:1265520381
Name:JOHNSON, GERALDINE (MSW)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:GERI
Other - Middle Name:
Other - Last Name:JONES-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3755 LIME AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-5471
Practice Address - Street 1:5901 E 7TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5471
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072693-11041C0700X
TNCSW00000065381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical