MEDICARE: LYDIA MARIE DUFFY LICSW

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	6804C	AL

General Provider Information

NPI Number	:	1285577338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA MARIE DUFFY LICSW

Provider Business Mailing Address
First Line	:	1720 2ND AVE S STE 307
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-2041
Country	:	US
Telephone Number	:	205-996-5004
Fax Number	:	205-975-2380

Provider Business Practice Location Address
First Line	:	930 20TH ST S STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2610
Country	:	US
Telephone Number	:	205-934-5471
Fax Number	:	205-975-2380

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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