Mayo R Funderburg II, LADCA
Counselor, Addiction (Substance Use Disorder) in Nantucket, Massachusetts
1053612192- Practice location
- 20 Vesper Ln Unit L1, Nantucket, MA 02554-4394
- Phone
- 508-228-2689
- Fax
- 508-228-3613
- Last updated
- November 5, 2010
Mayo R Funderburg is a Counselor, Addiction (Substance Use Disorder) based in Nantucket, MA. Mayo R Funderburg practices in Nantucket, MA and has the professional credentials of LADCA. The NPI Number for Mayo R Funderburg is 1053612192 and holds a License No. 2282 (MA). The current practice location address for Mayo R Funderburg is 20 Vesper Ln Unit L1, Nantucket, MA 02554-4394 and can be reached out via phone at 508-228-2689 and via fax at 508-228-3613.
Provider Profile Details
- NPI Number
- 1053612192
- Provider Name
- Mayo R Funderburg
- Credential
- LADCA
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 20 Vesper Ln Unit L1, Nantucket, MA 02554-4394
- Phone Number
- 508-228-2689
- Fax Number
- 508-228-3613
- Primary Taxonomy
- Counselor, Addiction (Substance Use Disorder) · 101YA0400X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- November 5, 2010
- Last Update Date
- November 5, 2010
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 20 Vesper Ln Unit L1
Nantucket, MA 02554-4394 - City
- Nantucket
- State
- Massachusetts
- Zip
- 02554-4394
- Phone Number
- 508-228-2689
- Fax Number
- 508-228-3613
Provider Business Mailing Address Details
- Address
- 20 Vesper Ln Unit L1
Nantucket, MA 02554-4394 - City
- Nantucket
- State
- MA
- Zip
- 02554-4394
- Phone Number
- 508-228-2689
- Fax Number
- 508-228-3613
License Information
- License Number
- 2282
- License State
- MA
- Taxonomy
- Counselor, Addiction (Substance Use Disorder) · 101YA0400X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mayo R Funderburg II, LADCA?
The NPI number of Mayo R Funderburg II, LADCA is 1053612192. It was assigned on November 5, 2010 and is currently active in the NPPES registry.
What is the specialty of Mayo R Funderburg II, LADCA?
Mayo R Funderburg II, LADCA is registered under the primary taxonomy Counselor, Addiction (Substance Use Disorder) (code 101YA0400X), licensed in MA under license number 2282.
Where does Mayo R Funderburg II, LADCA practice?
The practice location is 20 Vesper Ln Unit L1, Nantucket, MA 02554-4394. The office can be reached at 508-228-2689 (phone) or 508-228-3613 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1053612192 directly on the NPPES registry website.