Healthcare Provider Details

I. General information

NPI: 1447185277
Provider Name (Legal Business Name): LAUREN DUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W 69TH ST
CHICAGO IL
60621-1709
US

IV. Provider business mailing address

2838 MAPLE AVE
BERWYN IL
60402-2854
US

V. Phone/Fax

Practice location:
  • Phone: 703-772-9670
  • Fax:
Mailing address:
  • Phone: 703-772-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178020522
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: