Healthcare Provider Details

I. General information

NPI: 1104569607
Provider Name (Legal Business Name): JANET DUFFY, LICENSED MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 FIFTH AVENUE SUITE 3
NEW YORK NY
10029
US

IV. Provider business mailing address

1160 FIFTH AVENUE, SUITE 3 BOX 112
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 917-710-8388
  • Fax:
Mailing address:
  • Phone: 917-710-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET M DUFFY
Title or Position: OWNER
Credential: M.ED, LMHC, LPC
Phone: 917-710-8388