Provider Demographics
NPI:1346512209
Name:DUFFY, COLLEEN (APN, PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:APN, PMHCNS-BC
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:BORCHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, PMHCNS-BC
Mailing Address - Street 1:49 MAPLE ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:973-909-4078
Mailing Address - Fax:908-363-1030
Practice Address - Street 1:40 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1404
Practice Address - Country:US
Practice Address - Phone:201-291-0055
Practice Address - Fax:201-291-0888
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00264200364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent