Provider Demographics
NPI:1790217214
Name:CABIN JOHN PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:CABIN JOHN PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SORENSEN-TANENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PMH-NP, FNP-C
Authorized Official - Phone:301-741-6101
Mailing Address - Street 1:6500 SEVEN LOCKS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1300
Mailing Address - Country:US
Mailing Address - Phone:301-320-3701
Mailing Address - Fax:301-320-3774
Practice Address - Street 1:6500 SEVEN LOCKS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1300
Practice Address - Country:US
Practice Address - Phone:301-320-3701
Practice Address - Fax:301-320-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD196802084P0800X
MDR160645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty