Healthcare Provider Details

I. General information

NPI: 1881809762
Provider Name (Legal Business Name): DANIEL JOHN GLYNN JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S ERIE HWY
HAMILTON OH
45011-4118
US

IV. Provider business mailing address

1750 S ERIE HWY
HAMILTON OH
45011-4118
US

V. Phone/Fax

Practice location:
  • Phone: 513-477-9216
  • Fax:
Mailing address:
  • Phone: 513-477-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5607
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20042217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: