Provider Demographics
NPI:1861249153
Name:SUE CARROLL DUFFY, PSY.D., LLC SUSANNE CARROLL DUFFY SOLE MBR
Entity type:Organization
Organization Name:SUE CARROLL DUFFY, PSY.D., LLC SUSANNE CARROLL DUFFY SOLE MBR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-853-7246
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-0542
Mailing Address - Country:US
Mailing Address - Phone:207-853-7246
Mailing Address - Fax:
Practice Address - Street 1:471 GIN COVE RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:ME
Practice Address - Zip Code:04667-3034
Practice Address - Country:US
Practice Address - Phone:207-853-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty