Provider Demographics
NPI:1538787734
Name:LEIBEL, DANIEL KARL (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KARL
Last Name:LEIBEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1731
Mailing Address - Country:US
Mailing Address - Phone:845-558-2673
Mailing Address - Fax:
Practice Address - Street 1:361 BOILER HOUSE RD
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902-1104
Practice Address - Country:US
Practice Address - Phone:845-558-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06650103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist