Healthcare Provider Details

I. General information

NPI: 1770487514
Provider Name (Legal Business Name): ELINSON PENA HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2167
US

IV. Provider business mailing address

614 SLIGO AVE APT 401
SILVER SPRING MD
20910-6700
US

V. Phone/Fax

Practice location:
  • Phone: 202-984-2414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCACII200001309
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: