Provider Demographics
NPI:1780957829
Name:DUFFY, KATHERINE M (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:DUFFY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:HOSPITAL OF SAINT RAPHAEL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3363
Mailing Address - Fax:203-789-4081
Practice Address - Street 1:175 SHERMAN AVE
Practice Address - Street 2:TAKEHEART CARDIAC REHABILITATION
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4357
Practice Address - Country:US
Practice Address - Phone:203-789-3363
Practice Address - Fax:203-789-4081
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1066124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered