Provider Demographics
NPI:1114020278
Name:DUFFY, LAURA CARMICHAEL (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CARMICHAEL
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CARMICHAEL
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:17 PILGRIM LN
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482
Mailing Address - Country:US
Mailing Address - Phone:203-364-1688
Mailing Address - Fax:203-364-1688
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:UNIT C 23A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-364-1688
Practice Address - Fax:203-364-1688
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000054101YA0400X
CT000324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional