Robert Clinton Funk II, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00945812 Issued in WV

Practice address

207 Fairmont Ave
Fairmont, WV 26554-2710

Phone

(304) 698-1877

NPI assigned

Apr 3, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Appalachian Counseling Center LLCGroup PAC ID 5597115782, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Appalachian Counseling Center LLC

  • Psychologist
  • Fairmont, WV
  • NPI 1568928877

  Social Worker

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1801358478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 FAIRMONT AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542710",
            "telephone_number": "681-404-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FAIRMONT AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542710",
            "telephone_number": "304-698-1877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22221 Westernport Rd SW",
            "address_purpose": "LOCATION",
            "city": "Westernport",
            "state": "MD",
            "postal_code": "215622206",
            "country_code": "US",
            "telephone_number": "240-774-0204",
            "fax_number": "301-533-3299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNK",
        "first_name": "ROBERT",
        "middle_name": "CLINTON",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00945812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Ann Frush, LPTA
• Tina Renee Frye
• Jezzeriah Fulaytar
• Ashley Nicole Fultineer
• Gracie Fultineer
• Connie S Funovitz
• Mary Furrow
• G & C Diabetic Supply
• Frederick J Gabriele, MD
• Sherri Gallo

• Clinical Social Worker in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.