Healthcare Provider Details

I. General information

NPI: 1811313919
Provider Name (Legal Business Name): FONTHILL BEHAVIORAL HEALTH, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 17TH ST NW #530
WASHINGTON DC
20036-4704
US

IV. Provider business mailing address

1101 17TH ST NW STE 530
WASHINGTON DC
20036-4746
US

V. Phone/Fax

Practice location:
  • Phone: 240-271-1727
  • Fax:
Mailing address:
  • Phone: 240-271-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1000770
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. JOANNA MARIE MARINO
Title or Position: COO
Credential: PHD
Phone: 240-271-1727