Provider Demographics
NPI:1093217069
Name:DUFFORD, ANNA AMELISE (LMHC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:AMELISE
Last Name:DUFFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:AMELISE
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:516 WALL ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12824-2512
Mailing Address - Country:US
Mailing Address - Phone:518-223-5219
Mailing Address - Fax:
Practice Address - Street 1:516 WALL ST
Practice Address - Street 2:
Practice Address - City:DIAMOND POINT
Practice Address - State:NY
Practice Address - Zip Code:12824-2512
Practice Address - Country:US
Practice Address - Phone:518-223-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010343-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor