Provider Demographics
NPI:1467023242
Name:DUFFY, JOHN GEORGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:DUFFY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST CALENDAR AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:847-951-8000
Mailing Address - Fax:
Practice Address - Street 1:10 WEST CALENDAR AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:847-951-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-4398657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical