Provider Demographics
NPI:1588420665
Name:DUFFY, TRINICE (BCBA)
Entity type:Individual
Prefix:MISS
First Name:TRINICE
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26039 MASON RD
Mailing Address - Street 2:
Mailing Address - City:BLOXOM
Mailing Address - State:VA
Mailing Address - Zip Code:23308-2647
Mailing Address - Country:US
Mailing Address - Phone:757-894-5586
Mailing Address - Fax:
Practice Address - Street 1:26039 MASON RD
Practice Address - Street 2:
Practice Address - City:BLOXOM
Practice Address - State:VA
Practice Address - Zip Code:23308-2647
Practice Address - Country:US
Practice Address - Phone:757-894-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003462103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst