Provider Demographics
NPI:1588322952
Name:MARKOFF JOHNSON, AMY LYNNE (MA, AMFT 128972)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:MARKOFF JOHNSON
Suffix:
Gender:F
Credentials:MA, AMFT 128972
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CONNEMARA WAY APT 78
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3290
Mailing Address - Country:US
Mailing Address - Phone:408-857-8500
Mailing Address - Fax:
Practice Address - Street 1:340 SOQUEL AVE STE 107
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2328
Practice Address - Country:US
Practice Address - Phone:408-857-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist