Active NPI
Maryanne Duffy, MFT #26013
- Mental Health Counselor
- Lakewood, CA
National Provider Identifier
1942919717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFT26013
- Practice address
- 4537 Shadeway Rd
Lakewood, CA 90713-2833 - Phone
- (562) 241-9721
- NPI assigned
- Nov 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFT26013 | CA | Primary |
Addresses
Primary practice location
4537 Shadeway Rd
Lakewood, CA 90713-2833
Mailing address
4537 Shadeway Rd
Lakewood, CA 90713-2833
Phone (562) 241-9721
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2J05-D28-UN79 | Medicaid | CA | |
| E0627975 | Other | CA | DRIVERS LICENSE |
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 |
|---|---|---|---|
| MFT26013 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668988800000",
"number": "1942919717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4537 SHADEWAY RD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907132833",
"telephone_number": "562-241-9721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4537 SHADEWAY RD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907132833",
"telephone_number": "562-241-9721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUFFY",
"first_name": "MARYANNE",
"credential": "MFT #26013",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-21",
"last_updated": "2022-11-21",
"certification_date": "2022-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "MFT26013",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2J05-D28-UN79",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "E0627975",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.