Provider Demographics
NPI:1073994679
Name:DUFFY, EMILY WERWAISS (BACB, LBA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WERWAISS
Last Name:DUFFY
Suffix:
Gender:F
Credentials:BACB, LBA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JEAN
Other - Last Name:WERWAISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1728
Mailing Address - Country:US
Mailing Address - Phone:860-495-0126
Mailing Address - Fax:
Practice Address - Street 1:160 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-495-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14683103K00000X
CT465103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst