Provider Demographics
NPI:1821220450
Name:DANIELS, BETH ANN (PSYD, MA)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ARCH ST
Mailing Address - Street 2:#202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1821
Mailing Address - Country:US
Mailing Address - Phone:215-275-2850
Mailing Address - Fax:
Practice Address - Street 1:2542 BROWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1811
Practice Address - Country:US
Practice Address - Phone:215-236-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical