Provider Demographics
NPI:1548750391
Name:DUFAULT, EMMA KATHERINE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHERINE
Last Name:DUFAULT
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 1:67 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1849
Mailing Address - Country:US
Mailing Address - Phone:774-545-0401
Mailing Address - Fax:
Practice Address - Street 1:330 SW CUTOFF STE 203
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2730
Practice Address - Country:US
Practice Address - Phone:860-882-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician