Active NPI
Deborah Lynne San Juan, LCSW
- Clinical Social Worker
- Fairfield, CA
National Provider Identifier
1760194575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 80825
- Practice address
- 2825 Prestwick CT
Fairfield, CA 94534-7873 - Phone
- (707) 580-8273
- NPI assigned
- Dec 23, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 80825 | CA | Primary |
Addresses
Primary practice location
2825 Prestwick CT
Fairfield, CA 94534-7873
Mailing address
2825 Prestwick CT
Fairfield, CA 94534-7873
Phone (707) 580-8273
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80825 | Other | CA | BOARD OF BEHAVIORAL HEALTH |
Other names 1
- Deboran Lynne Johnson
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80825 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671753600000",
"number": "1760194575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2825 PRESTWICK CT",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945347873",
"telephone_number": "707-580-8273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2825 PRESTWICK CT",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945347873",
"telephone_number": "707-580-8273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAN JUAN",
"first_name": "DEBORAH",
"middle_name": "LYNNE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-23",
"last_updated": "2022-12-23",
"certification_date": "2022-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "80825",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIORAL HEALTH",
"identifier": "80825",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DEBORAN",
"last_name": "JOHNSON",
"middle_name": "LYNNE",
"credential": "LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.