NPIMap

Organization Active NPI

Funderburg Clinical and Community Services

Doing business as Funderburg CCS

  • Clinical Social Worker
  • Southfield, MI
National Provider Identifier
1225254279
Registry record updated Sep 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801086140 Issued in MI
Legal business name
FUNDERBURG CLINICAL AND COMMUNITY SERVICES
Doing business as
Funderburg CCS
Practice address
25438 Saint James
Southfield, MI 48075-1247
Phone
(248) 809-9105
Fax
(248) 659-1528
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gerald Roderick Funderburg Jr., LLMSW M.S.W
Title
Owner
Phone
(248) 809-9105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 6801086140 MI Primary

Addresses

Primary practice location

25438 Saint James
Southfield, MI 48075-1247

Mailing address

25438 Saint James
Southfield, MI 48075-1247
Phone (248) 809-9105

Other names 1

  • Funderburg CCS Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252627200000",
    "number": "1225254279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25438 SAINT JAMES",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751247",
            "telephone_number": "248-809-9105",
            "fax_number": "248-659-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25438 SAINT JAMES",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751247",
            "telephone_number": "248-809-9105",
            "fax_number": "248-659-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDERBURG CLINICAL AND COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2009-09-11",
        "status": "A",
        "authorized_official_last_name": "FUNDERBURG",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "RODERICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-809-9105",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LLMSW M.S.W"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801086140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Funderburg CCS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.