Provider Demographics
NPI:1861546731
Name:DANIELS, JOHN GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:DANIELS
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:PO BOX 470445
Mailing Address - Street 2:SUITE B
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0445
Mailing Address - Country:US
Mailing Address - Phone:407-518-0770
Mailing Address - Fax:407-518-9570
Practice Address - Street 1:221 RUBY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7200
Practice Address - Country:US
Practice Address - Phone:407-518-0770
Practice Address - Fax:407-518-9570
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL132088-000OtherMAGELLAN PROVIDER NO.
FL084375OtherMHN PROVIDER NUMBER
FLA777206OtherVALUE OPTIONS VENDER NO.
FL2000445OtherAETNA PROVIDER NO.
FL165795OtherCOMPSYCH PROVIDER NO.
FL59658OtherBC BS PROVIDER NUMBER
FL61-75810OtherUNITED HEALTHCARE PROV. N
FL110334OtherAMERIGROUP ID NO.
FL110334OtherAMERIGROUP ID NO.
FL59658OtherBC BS PROVIDER NUMBER