| Doctor Name: | DOUGLAS DUFORE |
| NPI Number: | 1174607113 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 002793 |
| Business Practice Address: | 633 Middlesex Tpke Suite 110 Old Saybrook, CT - 064751220 |
| Business Phone Number: | 8605100225 |
| Business Fax Number: | 8603951647 |
| Mailing Address: | 633 Middlesex Tpke, Suite 110 OLD SAYBROOK |
| State: | CT |
| Postal Code: | 064751220 |
| Phone Number: | 8605100225 |
| Fax Number: | 8603951647 |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 09/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 002793 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |