Provider Demographics
NPI:1821390345
Name:HASPEL-JOHNSON, DYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DYAN
Middle Name:
Last Name:HASPEL-JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1632
Mailing Address - Country:US
Mailing Address - Phone:310-482-7917
Mailing Address - Fax:310-496-0308
Practice Address - Street 1:610 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1632
Practice Address - Country:US
Practice Address - Phone:310-482-7917
Practice Address - Fax:310-496-0308
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical