Healthcare Provider Details

I. General information

NPI: 1649713223
Provider Name (Legal Business Name): KELLY ANN DUFF M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 COOPER HILL RD UNIT 6
WYNANTSKILL NY
12198-2906
US

IV. Provider business mailing address

42 MEADOW DR
TROY NY
12180-7713
US

V. Phone/Fax

Practice location:
  • Phone: 518-283-6500
  • Fax:
Mailing address:
  • Phone: 518-892-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: