Provider Demographics
NPI:1548290992
Name:JOHNSON, LAUREN JEANNE (PSYCHOLOGIST-MASTER)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:JEANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST-MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 VT ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:CRAFTSBURY COMMON
Mailing Address - State:VT
Mailing Address - Zip Code:05827-9500
Mailing Address - Country:US
Mailing Address - Phone:802-279-4636
Mailing Address - Fax:
Practice Address - Street 1:607 WASHINTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-8320
Practice Address - Fax:802-888-8136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000125101YA0400X
VT047-0000676103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1866Medicaid