Provider Demographics
NPI:1811374879
Name:J DANIELS PSYCHTHERAPY SERVICES, INC
Entity type:Organization
Organization Name:J DANIELS PSYCHTHERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:JENNENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-375-9220
Mailing Address - Street 1:6798 AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-3046
Mailing Address - Country:US
Mailing Address - Phone:301-375-9220
Mailing Address - Fax:
Practice Address - Street 1:6798 AMHERST RD
Practice Address - Street 2:
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616-3046
Practice Address - Country:US
Practice Address - Phone:301-375-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03791251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD36910005OtherCAREFIRST BCBS
MD528447OtherMAMSI
MD582M906FOtherMEDICARE
MD621210700Medicaid
MD003728OtherVALUE OPTIONS
MD1669470894OtherTRICARE/HNFS