Provider Demographics
NPI:1679957963
Name:JOHNSON, STEPHANIE (MA BCBA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28245 AVENUE CROCKER
Mailing Address - Street 2:STE 220
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0940
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:661-254-7108
Practice Address - Street 1:28245 AVENUE CROCKER
Practice Address - Street 2:STE 220
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0940
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:661-254-7108
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-16935103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst