Provider Demographics
NPI:1548648918
Name:DUFFY, ROBERT LEO III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEO
Last Name:DUFFY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HIGH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-0577
Mailing Address - Country:US
Mailing Address - Phone:508-404-5733
Mailing Address - Fax:
Practice Address - Street 1:205 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1406
Practice Address - Country:US
Practice Address - Phone:781-862-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherNHP
MA0000023532OtherBMC
MA042611055OtherTAX ID
MA1004745OtherFALLON
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA13003287OtherMBHP