Provider Demographics
NPI:1336138940
Name:DANIELS, ROBERT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 W BOGART RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5787
Mailing Address - Country:US
Mailing Address - Phone:419-626-8226
Mailing Address - Fax:419-621-0457
Practice Address - Street 1:1617 W BOGART RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5787
Practice Address - Country:US
Practice Address - Phone:419-626-8226
Practice Address - Fax:419-621-0457
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH587103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000130921OtherANTHEM
OH34135671800OtherBUREAU OF WORKERS COMP
000000130921OtherANTHEM
R60280Medicare UPIN