Provider Demographics
NPI:1609340595
Name:UMBRELLA FUNCTIONAL CONSULTING & SUPPORT TEAM, LLC
Entity Type:Organization
Organization Name:UMBRELLA FUNCTIONAL CONSULTING & SUPPORT TEAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:DUERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, GCT ABA
Authorized Official - Phone:610-470-3351
Mailing Address - Street 1:2113 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-6862
Mailing Address - Country:US
Mailing Address - Phone:610-470-3351
Mailing Address - Fax:
Practice Address - Street 1:2113 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6862
Practice Address - Country:US
Practice Address - Phone:610-470-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty