Healthcare Provider Details

I. General information

NPI: 1053239459
Provider Name (Legal Business Name): GABRIELLA MARIE DUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LIVERNOIS ST
FERNDALE MI
48220-2304
US

IV. Provider business mailing address

34070 BURTON LN
LIVONIA MI
48154-2556
US

V. Phone/Fax

Practice location:
  • Phone: 248-307-7496
  • Fax:
Mailing address:
  • Phone: 248-307-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: