Provider Demographics
NPI:1548597313
Name:ARENAZA, JOHANNA MIRYAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:MIRYAM
Last Name:ARENAZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1722
Mailing Address - Country:US
Mailing Address - Phone:202-441-5641
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 1225
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1722
Practice Address - Country:US
Practice Address - Phone:202-441-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical