Provider Demographics
NPI:1477866176
Name:FUNK, JANETTE LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:LYNN
Last Name:FUNK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 AVONMORE WAY
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1624
Mailing Address - Country:US
Mailing Address - Phone:413-884-4341
Mailing Address - Fax:585-273-1117
Practice Address - Street 1:1577 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3914
Practice Address - Country:US
Practice Address - Phone:413-884-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018667-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12130018OtherCAQH