Provider Demographics
NPI:1700623956
Name:DUFF, MADELYN ELISABETH
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:ELISABETH
Last Name:DUFF
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 1:5947 HORROCKS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3316
Mailing Address - Country:US
Mailing Address - Phone:215-280-2484
Mailing Address - Fax:
Practice Address - Street 1:196 W ASHLAND ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4040
Practice Address - Country:US
Practice Address - Phone:215-280-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician