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General NPI Number Information
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NPI Number | 1710176904
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Entity Type | Organization
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Legal Business Name | DD PSYCHOLOGY INC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 9720 STIRLING RD # 107
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City | HOLLYWOOD
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State | FL
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Zip | 33024-8013
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Country | US
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Telephone | 954-551-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 12994 SPRING LAKE DR
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City | COOPER CITY
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State | FL
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Zip | 33330-2749
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Country | US
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Telephone | 954-551-5678
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DONNA M DUFFIN
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Credential | PSY.D.
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Telephone | 954-551-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6676
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License Number State | FL
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