Provider Demographics
NPI:1255513834
Name:JOHANSEN, LEA LAFFOON (PSYD, ABPP)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:LAFFOON
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DEFENSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20373-0001
Mailing Address - Country:US
Mailing Address - Phone:703-692-8878
Mailing Address - Fax:
Practice Address - Street 1:1400 DEFENSE BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20373-0001
Practice Address - Country:US
Practice Address - Phone:703-692-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60192765103T00000X
TX37582103TC0700X
LA305803103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical