Provider Demographics
NPI:1669260501
Name:JOHNSON, JADA (MSW)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CENTINELA AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3252
Mailing Address - Country:US
Mailing Address - Phone:662-832-3804
Mailing Address - Fax:
Practice Address - Street 1:10810 PARAMOUNT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3351
Practice Address - Country:US
Practice Address - Phone:562-231-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1287731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical