Provider Demographics
NPI:1851466486
Name:DANIELS, HEIDI (PHD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MALCOLM GROW MEDICAL CENTER, JOINT BASE ANDREWS
Mailing Address - Street 2:1060 W. PERIMETER RD
Mailing Address - City:ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-857-7186
Mailing Address - Fax:
Practice Address - Street 1:1060 W PERIMETER RD
Practice Address - Street 2:
Practice Address - City:JB ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762-6602
Practice Address - Country:US
Practice Address - Phone:240-857-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03077103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC40150001OtherCAREFIRST BLUE CROSS
MDGN31OtherCAREFIRST BLUE CROSS
MDGN31OtherCAREFIRST BLUE CROSS