| Doctor Name: | ETHAN KANE DUFAULT |
| NPI Number: | 1396961272 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ETHAN DUFAULT, LICSW |
| License Number: | 113376 |
| Business Practice Address: | 500 Main St Ste, 5 Great Barrington, MA - 012302003 |
| Business Phone Number: | 4135282084 |
| Business Fax Number: | |
| Mailing Address: | 46 East St, MOUNT WASHINGTON |
| State: | MA |
| Postal Code: | 012589700 |
| Phone Number: | 4135289850 |
| Fax Number: | |
| NPI Enumeration Date: | 04/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 113376 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |