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General NPI Number Information
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NPI Number | 1326344003
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 111 MICHIGAN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone | 202-476-4447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27215
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City | BALTIMORE
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State | MD
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Zip | 21216-0715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SUSAN PFENNIG
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Credential | CPMSM
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Telephone | 202-476-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | HFD01-0208
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License Number State | DC
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