Provider Demographics
NPI:1598886566
Name:DUFFY, ZITA MARIE (MSW, LISW-S, CSW)
Entity Type:Individual
Prefix:
First Name:ZITA
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MSW, LISW-S, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9058
Mailing Address - Country:US
Mailing Address - Phone:800-532-7239
Mailing Address - Fax:
Practice Address - Street 1:2410 GRAPE RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3015
Practice Address - Country:US
Practice Address - Phone:574-217-0128
Practice Address - Fax:574-288-3447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008946A104100000X, 1041C0700X
OHI0009486-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261739Medicaid