Individual
MAYO R FUNDERBURG II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADCA
Contact information
Practice address
20 VESPER LN UNIT L1, NANTUCKET, MA 02554-4394
(508) 228-2689
(508) 228-3613
Mailing address
20 VESPER LN UNIT L1, NANTUCKET, MA 02554-4394
(508) 228-2689
(508) 228-3613
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2282
MA
Other
Enumeration date
11/05/2010
Last updated
11/05/2010
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