=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578616603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN PATRICK DUFFY PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 884 BRIGHTON RD
-----------------------------------------------------
City | TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14150-8169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-836-9460
-----------------------------------------------------
Fax | 716-836-9462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 884 BRIGHTON RD
-----------------------------------------------------
City | TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14150-8169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-836-9460
-----------------------------------------------------
Fax | 716-836-9462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 68 015908
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 68 015908
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 68 015908
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------