Individual
DR. MICHAEL RUNDLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
169 LIBBEY INDUSTRIAL PKWY, 2ND FLOOR, WEYMOUTH, MA 02189-3101
(781) 682-1060
(781) 682-1061
Mailing address
169 LIBBEY INDUSTRIAL PKWY, 2ND FLOOR, WEYMOUTH, MA 02189-3101
(781) 682-1060
(781) 682-1061
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4877
MA
103TH0100X
Health Service Psychologist
4877
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020923
VALUE OPTIONS PROVIDER NU
MA
01
—
110251000
MAGELLAN PROVIDER NUMBER
MA
01
—
6192642
EVERCARE PROVIDER NUMBER
MA
01
—
W04645
BCBS PROVIDER NUMBER
MA
Enumeration date
10/16/2006
Last updated
03/08/2010
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