Provider Demographics
NPI:1417130196
Name:DUNCAN, DEENA TERESA
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:TERESA
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11733 166TH ST FRNT HOUSE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-7002
Mailing Address - Country:US
Mailing Address - Phone:562-746-5137
Mailing Address - Fax:
Practice Address - Street 1:11733 166TH ST FRNT HOUSE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-7002
Practice Address - Country:US
Practice Address - Phone:562-746-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86701106H00000X
CAA05240315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)