Provider Demographics
NPI:1699949453
Name:FUNT, JACK (LPCLMHC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:FUNT
Suffix:
Gender:M
Credentials:LPCLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1617
Mailing Address - Country:US
Mailing Address - Phone:718-432-6236
Mailing Address - Fax:
Practice Address - Street 1:800 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1828
Practice Address - Country:US
Practice Address - Phone:718-432-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004461101YM0800X
NJ37PC00172400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional