Provider Demographics
NPI:1174829758
Name:DANIEL, SAMANTHA MAE (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MAE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 SALISBURY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6187
Mailing Address - Country:US
Mailing Address - Phone:646-941-7645
Mailing Address - Fax:929-596-7897
Practice Address - Street 1:4651 SALISBURY RD STE 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6187
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:929-596-7897
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12674103TC1900X
MD05333103TC1900X
NC4085103TC1900X
VA0810005069103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling