Jonathan Scott Runge, PSY.D.
Individual provider Active NPI Clinical Psychologist · Provincetown, MA
NPI 1689730665 · NPPES record last updated Jun 8, 2015
Key facts
- NPI
- 1689730665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 9711 (MA)
- Practice address
- 30 Conwell St
Provincetown, MA 02657-1548 - Phone
- (617) 901-1196
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9711 | MA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 23772 | CA | |
| Clinical Psychologist | 103TC0700X | 9711 | MA | Yes |
Addresses
Primary practice location
30 Conwell St
Provincetown, MA 02657-1548
Mailing address
PO Box 1861
Provincetown, MA 02657-0245
Phone (617) 901-1196
Other providers in Provincetown, MA
- Quest Diagnostics Massachusetts LLC
- Walter M Richter
- Aneta Roderick
- Susan H. Roderick
- Matthew William Ruble
- Piotr Sapinski
- Mark Edward Schiffman
- Seashore Point
- Seashore Point - Deaconess Inc
- Seashore Point Wellness and Rehab
All providers in Provincetown, MA · Clinical Psychologist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.