Provider Demographics
NPI:1285781815
Name:DUFFY, MARY ANN (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9694
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-0012
Mailing Address - Country:US
Mailing Address - Phone:508-965-9532
Mailing Address - Fax:774-294-5944
Practice Address - Street 1:654 HIGH ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3451
Practice Address - Country:US
Practice Address - Phone:508-965-9532
Practice Address - Fax:774-294-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03779Medicare ID - Type Unspecified