Provider Demographics
NPI:1952584013
Name:CARRERA, JOHNNY A (MFT INTERN)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:A
Last Name:CARRERA
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:A
Other - Last Name:CARRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:54015
Mailing Address - Street 1:8760 PARKCLIFF ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-5232
Mailing Address - Country:US
Mailing Address - Phone:323-481-0653
Mailing Address - Fax:
Practice Address - Street 1:10221 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2804
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:323-566-1638
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9999AOtherDMH