Nicholette Dawn Johnson

Primary specialty

Social WorkerTaxonomy code 104100000X

License

89288 Issued in CA

Practice address

670 W Baseline Rd
San Dimas, CA 91773-1492

Phone

(909) 741-7124

NPI assigned

Sep 10, 2019

Last updated

May 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heritage Group Homes Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Dimas, CA
  • NPI 1033784426
  NPD
• Heritage Group Homes Inc.

  • Community/Behavioral Health Agency
  • Covina, CA
  • NPI 1346804432
  NPD (past)
• Heritage Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phillips Ranch, CA
  • NPI 1013469881
  NPD (past)
• Heritage Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • La Verne, CA
  • NPI 1285186981
  NPD (past)
• Heritage Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • West Covina, CA
  • NPI 1306398185
  NPD (past)
• Heritage Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • West Covina, CA
  • NPI 1396297172
  NPD (past)
• Heritage Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Valinda, CA
  • NPI 1467904235
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1053960245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E PAYSON ST",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732227",
            "telephone_number": "909-993-3287",
            "fax_number": "909-599-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 W BASELINE RD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731492",
            "telephone_number": "909-741-7124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1940 Baseline Rd",
            "address_purpose": "LOCATION",
            "city": "LA Verne",
            "state": "CA",
            "postal_code": "917502148",
            "country_code": "US",
            "telephone_number": "909-392-1344",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3340 E Whitebirch Dr",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917913039",
            "country_code": "US",
            "telephone_number": "626-430-6864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8814 Santa Fe Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Whittier",
            "state": "CA",
            "postal_code": "906062821",
            "country_code": "US",
            "telephone_number": "562-698-1062",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1923 E Eckerman Ave",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917911113",
            "country_code": "US",
            "telephone_number": "626-332-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16226 E Benwick St.",
            "address_purpose": "LOCATION",
            "city": "Valinda",
            "state": "CA",
            "postal_code": "917441301",
            "country_code": "US",
            "telephone_number": "626-917-0857",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Country Wood Dr",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917664818",
            "country_code": "US",
            "telephone_number": "909-332-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "158 Gentry St",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917672100",
            "country_code": "US",
            "telephone_number": "909-599-8222",
            "fax_number": "909-599-8223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICHOLETTE",
        "middle_name": "DAWN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "89288",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "89288",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "89288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Jeong, D.D.S
• Ryan Jilbert
• Jacqueline Jimenez
• Cathleen Croft Johnson, OTR/L
• Cierra Elaine Johnson
• Ralph E. Johnson, D.C.
• Sarina J Johnson, PTA
• Taylor Johnson
• Zina Lynn Johnson
• Jonathan F Cook, MD Inc

• Social Worker in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.