Provider Demographics
NPI:1649357419
Name:DUFF, ANDREA LEE (MA,)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:DUFF
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 PEBBLE BEACH DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5812
Mailing Address - Country:US
Mailing Address - Phone:505-301-2971
Mailing Address - Fax:
Practice Address - Street 1:4800 GOODRICH AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1139
Practice Address - Country:US
Practice Address - Phone:505-301-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33807752Medicaid