MEDICARE: MRS. LAURA DUFFY PLAYER LMHC

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	101YM0800X	Mental Health Counselor	PMH1482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10331327	OTHER		INSURANCE

General Provider Information

NPI Number	:	1578092631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA DUFFY PLAYER LMHC

Provider Business Mailing Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	06/12/2017

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