Provider Demographics
NPI:1619180858
Name:DUFFY, ALICE R (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3357
Mailing Address - Country:US
Mailing Address - Phone:800-922-7009
Mailing Address - Fax:877-730-5113
Practice Address - Street 1:401 E 10TH AVE STE 330
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3357
Practice Address - Country:US
Practice Address - Phone:800-922-7009
Practice Address - Fax:877-730-5113
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL18201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical