Provider Demographics
NPI:1811192990
Name:HENNESSY, ERIN KATHLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHLEEN
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HENNESSY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2821 MANKIN WALK
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2234
Mailing Address - Country:US
Mailing Address - Phone:703-618-0900
Mailing Address - Fax:
Practice Address - Street 1:220 S WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3626
Practice Address - Country:US
Practice Address - Phone:703-618-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist