MEDICARE: THERESA GAY DUFFEY LCSW

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	1041C0700X	Clinical Social Worker	0904010278	VA

General Provider Information

NPI Number	:	1184120164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA GAY DUFFEY LCSW

Provider Business Mailing Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3447
Country	:	US
Telephone Number	:	434-575-1336
Fax Number	:	434-575-1349

Provider Business Practice Location Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3447
Country	:	US
Telephone Number	:	434-575-1336
Fax Number	:	434-575-1349

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/30/2018

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