Provider Demographics
NPI:1285968800
Name:JOHANSSON, MAYA RACHEL (MA)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:RACHEL
Last Name:JOHANSSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 RHODE ISLAND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5185
Mailing Address - Country:US
Mailing Address - Phone:415-238-0898
Mailing Address - Fax:
Practice Address - Street 1:383 RHODE ISLAND ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5185
Practice Address - Country:US
Practice Address - Phone:415-238-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF61313106H00000X
CA51090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist