MEDICARE: MS. KAREN DUFFY MFTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF51997	CA

General Provider Information

NPI Number	:	1144551789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN DUFFY MFTI

Provider Business Mailing Address
First Line	:	1500 PETALUMA BLVD S
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5545
Country	:	US
Telephone Number	:	707-765-8488
Fax Number	:	707-765-8482

Provider Business Practice Location Address
First Line	:	1500 PETALUMA BLVD S
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-5545
Country	:	US
Telephone Number	:	707-765-8488
Fax Number	:	707-765-8482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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