Healthcare Provider Details

I. General information

NPI: 1811374879
Provider Name (Legal Business Name): J DANIELS PSYCHTHERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6798 AMHERST RD
BRYANS ROAD MD
20616-3046
US

IV. Provider business mailing address

6798 AMHERST RD
BRYANS ROAD MD
20616-3046
US

V. Phone/Fax

Practice location:
  • Phone: 301-375-9220
  • Fax:
Mailing address:
  • Phone: 301-375-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number03791
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier36910005
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST BCBS
# 2
Identifier528447
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerMAMSI
# 3
Identifier582M906F
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerMEDICARE
# 4
Identifier621210700
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 5
Identifier003728
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerVALUE OPTIONS
# 6
Identifier1669470894
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerTRICARE/HNFS

VIII. Authorized Official

Name: JENNENE DANIELS
Title or Position: PRES.
Credential: LCSW-C
Phone: 301-375-9220