=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821220450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH ANN DANIELS PSYD, MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2009
-----------------------------------------------------
Last Update Date | 08/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2542 BROWN ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-236-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 ARCH ST #202
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19106-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-275-2850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS016660
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------