Active NPI
Susan Elizabeth Funk, PSY.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1063576684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3818
- Practice address
- 501 S Sharon Amity Rd Ste 500
Charlotte, NC 28211-2897 - Phone
- (704) 655-7544
- NPI assigned
- Dec 20, 2006
- Last updated
- Jan 15, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3818 | NC | Primary |
Addresses
Primary practice location
501 S Sharon Amity Rd Ste 500
Charlotte, NC 28211-2897
Mailing address
6907 Rollingridge Dr
Charlotte, NC 28211-5466
Phone (724) 464-7745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 20, 2018 through Jul 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3818 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1063576684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6907 ROLLINGRIDGE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282115466",
"telephone_number": "724-464-7745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S SHARON AMITY RD STE 500",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112897",
"telephone_number": "704-655-7544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNK",
"first_name": "SUSAN",
"middle_name": "ELIZABETH",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.