Provider Demographics
NPI:1083193148
Name:DUFFORD, ELAINE B (LMSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:DUFFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6901
Mailing Address - Country:US
Mailing Address - Phone:208-746-5906
Mailing Address - Fax:833-264-6643
Practice Address - Street 1:1229 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6901
Practice Address - Country:US
Practice Address - Phone:208-746-5906
Practice Address - Fax:833-264-6643
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker