Individual
MS. CHRISTINE NICOLE RUNYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 441-6225
(508) 334-8835
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1133
NH
103T00000X
Psychologist
205032795
MO
103TC0700X
Clinical Psychologist
Primary
9111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110087573A
—
MA
05
—
490939709
—
MO
01
—
RE4060
MEDICARE GROUP
NH
Enumeration date
08/25/2006
Last updated
10/30/2020
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