Provider Demographics
NPI:1851466486
Name:DANIELS, HEIDI (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DANIELS
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3077103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC40150001OtherCAREFIRST BLUE CROSS
MDGN31OtherCAREFIRST BLUE CROSS
MDGN31OtherCAREFIRST BLUE CROSS