Timothy Gordon Runk, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1255 Issued in NH

Practice address

16 Fifth St
Dover, NH 03820-2950

Phone

(603) 749-4462

Fax

(603) 749-2475

NPI assigned

Oct 24, 2012

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 NH

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Counseling Center of Nashua IncGroup PAC ID 3274523758, 250 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.

• The Counseling Center of Nashua Inc

  dba LifeStance Health

  • Clinical Psychologist
  • Nashua, NH
  • NPI 1144275389
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351036800000",
    "number": "1790038008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 FIFTH ST",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202950",
            "telephone_number": "603-749-4462",
            "fax_number": "603-749-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 FIFTH ST",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202950",
            "telephone_number": "603-749-4462",
            "fax_number": "603-749-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNK",
        "first_name": "TIMOTHY",
        "middle_name": "GORDON",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "1255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Enright Roux, LICSW
• Peter L Row, MD
• Olivia Glenn Rowell
• Kaitlyn A Rumford, PT, DPT
• Chad Douglas Rumney, PT
• Emily Rush
• Ruby Rush, LICSW
• Jeffrey Russell, MD
• Katelyn Russell, PT, DPT
• Tressa Renee Ryan, MSW, LICSW

• Clinical Social Worker in Dover, NH
• Providers in Dover, NH by specialty
• Clinical Social Worker in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; 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.