Provider Demographics
NPI:1952814816
Name:DUFFY, JENNIFER NOEL (PH D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NOEL
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67A LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1638
Mailing Address - Country:US
Mailing Address - Phone:631-239-6067
Mailing Address - Fax:631-239-6064
Practice Address - Street 1:67A LAUREL HILL RD
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1638
Practice Address - Country:US
Practice Address - Phone:631-239-6067
Practice Address - Fax:631-239-6064
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical