Active NPI
Pearl M Johnson, PH.D. LCSW
- Clinical Social Worker
- Florissant, MO
National Provider Identifier
1184913238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 001180
- Practice address
- 11333 Sugar Pine Dr
Ste. 901
Florissant, MO 63033-6734 - Phone
- (314) 803-2808
- NPI assigned
- Mar 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 001180 | MO | Primary |
Addresses
Primary practice location
11333 Sugar Pine Dr
Ste. 901
Florissant, MO 63033-6734
Mailing address
11333 Sugar Pine Dr
Ste. 901
Florissant, MO 63033-6734
Phone (314) 803-2808
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 493347207 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001180 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345507200000",
"number": "1184913238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11333 SUGAR PINE DR",
"address_2": "STE. 901",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630336734",
"telephone_number": "314-803-2808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11333 SUGAR PINE DR",
"address_2": "STE. 901",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630336734",
"telephone_number": "314-803-2808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PEARL",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D. LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-29",
"last_updated": "2012-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "001180",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "493347207",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.