Healthcare Provider Details

I. General information

NPI: 1124172226
Provider Name (Legal Business Name): JOANNE DUFFY PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 504
BALTIMORE MD
21215-5232
US

IV. Provider business mailing address

2411 W BELVEDERE AVE STE 504
BALTIMORE MD
21215-5232
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-0070
  • Fax: 410-601-0290
Mailing address:
  • Phone: 410-601-0070
  • Fax: 410-601-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2700
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: