Provider Demographics
NPI:1245383959
Name:DUFF, JASON MICHAEL (PSYD STUDENT, NP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:DUFF
Suffix:
Gender:M
Credentials:PSYD STUDENT, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 KNORR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2113
Mailing Address - Country:US
Mailing Address - Phone:267-981-3588
Mailing Address - Fax:
Practice Address - Street 1:314 E STATE ST # 316
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1810
Practice Address - Country:US
Practice Address - Phone:609-396-4258
Practice Address - Fax:609-396-3499
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program