Healthcare Provider Details

I. General information

NPI: 1255568325
Provider Name (Legal Business Name): ERIN PATRICK JOHANNESEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 17TH STREET, NW SUITE 203 CENTRAL WASHINGTON PSYCHOTHERAPY ASSOCIATES
WASHINGTON, DC DC
20009-2419
US

IV. Provider business mailing address

2707 ADAMS MILL RD NW APT. 509
WASHINGTON DC
20009-2178
US

V. Phone/Fax

Practice location:
  • Phone: 202-496-9911
  • Fax: 202-250-7990
Mailing address:
  • Phone: 202-667-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0116012615
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD038035
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: