Provider Demographics
NPI:1306364930
Name:DUFTY, AMANDA JOY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:DUFTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MILL RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1764
Mailing Address - Country:US
Mailing Address - Phone:313-333-7869
Mailing Address - Fax:828-696-1794
Practice Address - Street 1:415 MILL RD BLDG A
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1764
Practice Address - Country:US
Practice Address - Phone:313-333-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011201261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical