1. Home
  2. Directory
  3. Massachusetts
  4. Nantucket
  5. Counselor
  6. NPI Profile

MAYO R FUNDERBURG II LADCA
NPI 1053612192
Counselor - Addiction (Substance Use Disorder) in Nantucket, MA

Active since November 05, 2010
20 VESPER LN UNIT L1, NANTUCKET, MA 02554(508) 228-2689(508) 228-3613 Get Directions Write a Review

NPPES record last updated: November 5, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mayo R Funderburg Ii Ladca NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAYO R FUNDERBURG II LADCA (NPI 1053612192) is an individual addiction (substance use disorder) provider in Nantucket, Massachusetts, licensed in Massachusetts (2282) and active in the NPI registry since November 2010.

NPPES Registry Identity

NPI1053612192
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMAYO R FUNDERBURG IICredential: LADCA
Location Address20 VESPER LN UNIT L1Nantucket, MA 02554-4394
Mailing Address20 Vesper Ln Unit L1Nantucket, MA 02554-4394 · (508) 228-2689 · Fax (508) 228-3613
Phone(508) 228-2689
Fax(508) 228-3613
Sole ProprietorYes
Enumeration DateNovember 5, 2010
✔ NPI 1053612192 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in MA · 2282
20 VESPER LN UNIT L1, Nantucket, MA 02554
Open in Google Maps ↗

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. NANCY PALCHANIS FUNDERBURG LCSW
Social Worker
20 VESPER LN UNIT L1, NANTUCKET BEHAVIORAL HEALTH SERVICES
NANTUCKET, MA 02554
Nantucket County (508) 228-2689
ALISON LEE UPRIGHT
Counselor
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (508) 228-2869
NATASHA FEENEY RN
Nurse Practitioner (Psychiatric/Mental Health)
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (508) 228-2689
MRS. TESSANDRA NOEL DE ALBERDI VISCO MS, CRC
Counselor (Mental Health)
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (502) 228-2689
MISS EVIE O'CONNOR BS
Counselor
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (508) 228-2689
KATE WERNER
Counselor (Mental Health)
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (508) 228-2689
MEGAN HARVEY MSW
Social Worker (Clinical)
20 VESPER LN UNIT L1
NANTUCKET, MA 02554
Nantucket County (508) 228-2689

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mayo Funderburg's NPI number?

The NPI number for Mayo Funderburg is 1053612192. It was assigned to this individual provider in the NPPES registry on November 5, 2010.

Where is Mayo Funderburg located?

Mayo Funderburg practices at 20 Vesper Ln Unit L1, Nantucket, MA 02554. The listed phone number is (508) 228-2689.

What is Mayo Funderburg's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Mayo Funderburg was last updated on November 5, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.