Provider Demographics
NPI:1124271788
Name:FUNDERBURG, NANCY PALCHANIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:PALCHANIS
Last Name:FUNDERBURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 VESPER LN UNIT L1
Mailing Address - Street 2:NANTUCKET BEHAVIORAL HEALTH SERVICES
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4394
Mailing Address - Country:US
Mailing Address - Phone:508-228-2689
Mailing Address - Fax:
Practice Address - Street 1:20 VESPER LN UNIT L1
Practice Address - Street 2:NANTUCKET BEHAVIORAL HEALTH SERVICES
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4394
Practice Address - Country:US
Practice Address - Phone:508-228-2689
Practice Address - Fax:508-228-3613
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215268104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical