Organization
CHILDREN'S HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN PFENNIG CPMSM (MANAGER)
(202) 476-4447
Entity
Organization
Contact information
Practice address
111 MICHIGAN AVE NW, WASHINGTON, DC 20010-2916
(202) 476-4447
Mailing address
PO BOX 27215, BALTIMORE, MD 21216-0715
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
HFD01-0208
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000900168
—
VA
05
—
027980100
—
DC
05
—
658091200
—
MD
Enumeration date
01/28/2011
Last updated
01/28/2011
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