Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY23615 | CA |
Y | 103T00000X | Psychologist | PSY23615 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY23615 | CA |
N | 103G00000X | Clinical Psychologist | PSY23615 | CA |
N | 103TC0700X | Clinical Psychologist | PSY23615 | CA |
N | 103TH0100X | Health Service | PSY23615 | CA |
NPI | 1003164070 |
---|---|
Provider Name | Dr. Leanor M Johansen |
First Address | Downey, CA 90242-2001 |
Second Address | Downey, CA 90242-2001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2012 |
Last Update Date | 24/08/2012 |