Active NPI
Michael J. Duffy Jr., ED.D., L.L.P.
- Clinical Psychologist
- Fort Gratiot, MI
National Provider Identifier
1356367049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301002476
- Practice address
- 1501 Krafft Rd
Fort Gratiot, MI 48059-3565 - Phone
- (810) 985-5125
- Fax
- (810) 985-5127
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301002476 | MI | Primary |
Addresses
Primary practice location
1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Mailing address
1501 Krafft Rd
Fort Gratiot, MI 48059-3565
Phone (810) 985-5125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301002476 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356367049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KRAFFT RD",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480593565",
"telephone_number": "810-985-5125",
"fax_number": "810-985-5127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 KRAFFT RD",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480593565",
"telephone_number": "810-985-5125",
"fax_number": "810-985-5127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUFFY",
"first_name": "MICHAEL",
"middle_name": "J.",
"name_suffix": "Jr.",
"credential": "ED.D., L.L.P.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301002476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gratiot, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.