Healthcare Provider Details

I. General information

NPI: 1518022359
Provider Name (Legal Business Name): KATHLEEN ROSE DUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BITTERSWEET CIR
PLYMOUTH MA
02360-1585
US

IV. Provider business mailing address

16 BITTERSWEET CIR
PLYMOUTH MA
02360-1585
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-4137
  • Fax: 508-224-2762
Mailing address:
  • Phone: 508-224-4137
  • Fax: 508-224-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: