Provider Demographics
NPI:1760859136
Name:DUFFY, MAYA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
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 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:386-454-0690
Practice Address - Street 1:911 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3239
Practice Address - Country:US
Practice Address - Phone:352-463-2374
Practice Address - Fax:352-463-2726
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW19573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor