Provider Demographics
NPI:1881809762
Name:GLYNN, DANIEL JOHN JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:GLYNN
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S ERIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4118
Mailing Address - Country:US
Mailing Address - Phone:513-477-9216
Mailing Address - Fax:
Practice Address - Street 1:1750 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4118
Practice Address - Country:US
Practice Address - Phone:513-477-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042217A103TH0100X
OH5607103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service