Healthcare Provider Details

I. General information

NPI: 1346512209
Provider Name (Legal Business Name): COLLEEN DUFFY APN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN BORCHERT APN, PMHCNS-BC

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 EISENHOWER DR
PARAMUS NJ
07652-1404
US

IV. Provider business mailing address

49 MAPLE ST. SUITE 401
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 201-291-0055
  • Fax: 201-291-0888
Mailing address:
  • Phone: 973-909-4078
  • Fax: 908-363-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00264200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: