Provider Demographics
NPI:1750938783
Name:DUFFY, JAMES MATTHEW (LCADC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:DUFFY
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2588
Mailing Address - Country:US
Mailing Address - Phone:301-661-8216
Mailing Address - Fax:
Practice Address - Street 1:20 APPEAL LN
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2935
Practice Address - Country:US
Practice Address - Phone:410-394-0681
Practice Address - Fax:410-326-1860
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCA1618OtherLICENSE