1548290992 NPI number — MS. LAUREN JEANNE JOHNSON PSYCHOLOGIST-MASTER

Table of content: MS. LAUREN JEANNE JOHNSON PSYCHOLOGIST-MASTER (NPI 1548290992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548290992 NPI number — MS. LAUREN JEANNE JOHNSON PSYCHOLOGIST-MASTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
LAUREN
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST-MASTER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548290992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6213 VT ROUTE 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRAFTSBURY COMMON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05827-9500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-279-4636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 WASHINTON HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05661-8652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-888-8320
Provider Business Practice Location Address Fax Number:
802-888-8136
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000125 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: 047-0000676 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OVN1866 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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