Provider Demographics
NPI:1972652923
Name:HOLLER, DANIEL LEE (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:HOLLER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 WILDROSE CT
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-7601
Mailing Address - Country:US
Mailing Address - Phone:410-259-1013
Mailing Address - Fax:
Practice Address - Street 1:15601 WILDROSE CT
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:MD
Practice Address - Zip Code:21776-7601
Practice Address - Country:US
Practice Address - Phone:410-259-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5867595OtherAETNA PROVIDER
MD527BCEOtherCARE FIRST MD PROVIDER
DCR6290013OtherCAREFIRST
MD68541203OtherCAREFIRST
MD68541204OtherCAREFIRST
MD100024852OtherAPS
MDK2800001OtherBLUE CHOICE PROVIDER