MAYO R FUNDERBURG LADCA NPI 1053612192

NPI Information

NPI: 1053612192
Provider Name: MAYO R FUNDERBURG, LADCA
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
20 VESPER LN UNIT L1
NANTUCKET, MA
ZIP 02554
Phone: (508) 228-2689
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Mayo R Funderburg, LADCA is an addiction (substance use disorder) counselor in Nantucket, MA. Mayo R Funderburg, LADCA NPI is 1053612192. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

20 VESPER LN UNIT L1
NANTUCKET, MA
ZIP 02554-394
Phone: (508) 228-2689
Fax: (508) 228-3613

The enumeration date for this NPI number is 11/5/2010 and was last updated on 11/5/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	2282	MASSACHUSETTS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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