Provider Demographics
NPI:1811313919
Name:FONTHILL BEHAVIORAL HEALTH, LLP
Entity type:Organization
Organization Name:FONTHILL BEHAVIORAL HEALTH, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-271-1727
Mailing Address - Street 1:1101 17TH ST NW STE 530
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4746
Mailing Address - Country:US
Mailing Address - Phone:240-271-1727
Mailing Address - Fax:
Practice Address - Street 1:1101 17TH ST NW
Practice Address - Street 2:#530
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4704
Practice Address - Country:US
Practice Address - Phone:240-271-1727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
DC1000770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty