Provider Demographics
NPI:1518022359
Name:DUFFY, KATHLEEN ROSE
Entity type:Individual
Prefix:
First Name:KATHLEEN ROSE
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BITTERSWEET CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1585
Mailing Address - Country:US
Mailing Address - Phone:508-224-4137
Mailing Address - Fax:508-224-2762
Practice Address - Street 1:16 BITTERSWEET CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1585
Practice Address - Country:US
Practice Address - Phone:508-224-4137
Practice Address - Fax:508-224-2762
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
36104OtherNCC FROM NBCC
MA410013OtherLSWA