Provider Demographics
NPI:1538324595
Name:HEIDI DANIELS, PH.D., P.A.
Entity Type:Organization
Organization Name:HEIDI DANIELS, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-943-2245
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-0160
Mailing Address - Country:US
Mailing Address - Phone:301-943-2245
Mailing Address - Fax:410-257-5286
Practice Address - Street 1:65 DUKE ST.
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:301-943-2245
Practice Address - Fax:410-257-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3077103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC40150001OtherFEDERAL BLUE CROSS
MDGN31OtherCAREFIRST BLUE CROSS OF MARYLAND
MDGN31OtherCAREFIRST BLUE CROSS OF MARYLAND