Provider Demographics
NPI:1154450070
Name:DUFFIN, DONNA MARIE (PSY D)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:DUFFIN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12994 SPRING LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-551-5678
Mailing Address - Fax:954-434-9036
Practice Address - Street 1:9720 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8013
Practice Address - Country:US
Practice Address - Phone:954-551-5678
Practice Address - Fax:954-434-9036
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6676103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
73008Medicare ID - Type Unspecified