Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | PSY21142 | CA |
N | 103G00000X | Clinical Psychologist | PSY21142 | CA |
N | 103TC0700X | Clinical Psychologist | PSY21142 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY21142 | CA |
N | 103TP2701X | Group Psychotherapist | PSY21142 | CA |
NPI | 1346321742 |
---|---|
Provider Name | Dr. Abby Marie Brewer-Johnson |
First Address | San Diego, CA 92024 |
Second Address | San Diego, CA 92103-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |