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1053612192
MAYO R FUNDERBURG
NANTUCKET, MA
NPI
1053612192
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: MA 2282)
Enumeration Date
2010-11-05
Last Update Date
2010-11-05
Business Address
MAYO R FUNDERBURG LADCA
20 VESPER LN UNIT L1
NANTUCKET, MA 02554-4394
Phone number: 508-228-2689
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Mailing Address
MAYO R FUNDERBURG LADCA
20 VESPER LN UNIT L1
NANTUCKET, MA 02554-4394
Phone number: 508-228-2689
Copy
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