Provider Demographics
NPI:1831230499
Name:JOHNSON-SCHROETLIN, CAROL A (PSYD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:JOHNSON-SCHROETLIN
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0779
Mailing Address - Country:US
Mailing Address - Phone:831-623-2930
Mailing Address - Fax:
Practice Address - Street 1:605 TENNANT AVE STE I
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5529
Practice Address - Country:US
Practice Address - Phone:408-887-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY19303OtherCLINICAL PSYCHOLOGIST