Provider Demographics
NPI:1275951386
Name:FUNK, MARJORIE LYNN (PSYD, EDS)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:LYNN
Last Name:FUNK
Suffix:
Gender:F
Credentials:PSYD, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 LINDEMANN DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1532
Mailing Address - Country:US
Mailing Address - Phone:513-262-2891
Mailing Address - Fax:
Practice Address - Street 1:115 S LUDLOW ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1812
Practice Address - Country:US
Practice Address - Phone:934-542-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist