Provider Demographics
NPI:1992916134
Name:JOHNSON-GEORGE, CYNTHIA L (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:JOHNSON-GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3847
Mailing Address - Country:US
Mailing Address - Phone:626-244-7723
Mailing Address - Fax:703-356-3461
Practice Address - Street 1:685 E CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3847
Practice Address - Country:US
Practice Address - Phone:626-244-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000964103TC2200X
CA5894103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent