Provider Demographics
NPI:1447318811
Name:DUFFY, BRIAN P (LMHC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:DUFFY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 AUBURNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1420
Mailing Address - Country:US
Mailing Address - Phone:617-969-1328
Mailing Address - Fax:
Practice Address - Street 1:126 AUBURNDALE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1420
Practice Address - Country:US
Practice Address - Phone:617-969-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health