Provider Demographics
NPI:1770508129
Name:MCLEOD, DANIEL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:MCLEOD
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 1:21 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2317
Mailing Address - Country:US
Mailing Address - Phone:410-303-3787
Mailing Address - Fax:410-825-0310
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2317
Practice Address - Country:US
Practice Address - Phone:410-303-3787
Practice Address - Fax:410-825-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25691OtherEHP ID NUMBER
MDGP57DROtherCAREFIRST BC/BS
MD305RMedicare ID - Type UnspecifiedPROVIDER ID