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General NPI Number Information
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NPI Number | 1174829758
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Entity Type | Individual
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Provider Name | SAMANTHA MAE DANIEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY12674
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 05333
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 4085
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 0810005069
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License Number State | VA
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