Provider Demographics
NPI:1184062978
Name:DUFFY, TERESA MARIE (CADC INTERN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:CADC INTERN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:LIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 S PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4730
Mailing Address - Country:US
Mailing Address - Phone:775-882-3945
Mailing Address - Fax:775-882-6126
Practice Address - Street 1:900 E LONG ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3129
Practice Address - Country:US
Practice Address - Phone:775-882-3945
Practice Address - Fax:775-882-6126
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01246-INTERN171M00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner