Douglas Dufore, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002793 Issued in CT

Practice address

633 Middlesex Tpke
Suite 110
Old Saybrook, CT 06475-1220

Phone

(860) 510-0225

Fax

(860) 395-1647

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ddufore133928@direct.ynhh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379635200000",
    "number": "1174607113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 MIDDLESEX TPKE",
            "address_2": "SUITE 110",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751220",
            "telephone_number": "860-510-0225",
            "fax_number": "860-395-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 MIDDLESEX TPKE",
            "address_2": "SUITE 110",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751220",
            "telephone_number": "860-510-0225",
            "fax_number": "860-395-1647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFORE",
        "first_name": "DOUGLAS",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2013-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Sleep Providers, LLC
• Bruce Robert Dickerman, RPH
• Randi B Diemand, LCSW
• Donna Olivieri LCSW
• Lauren Larusso Drago, LMHC, LPC
• Michael William Dunne, MD
• Alyssa Ann Duperry, APRN
• East Coast Anesthesia
• Robert Ladd Edmonstone, DDS
• Matthew E Elgart, OD

• Clinical Psychologist in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.