Individual
JONATHAN SCOTT RUNGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
30 CONWELL ST, PROVINCETOWN, MA 02657-1548
(617) 901-1196
Mailing address
PO BOX 1861, PROVINCETOWN, MA 02657-0245
(617) 901-1196
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
23772
CA
103TC0700X
Clinical Psychologist
Primary
9711
MA
Other
Enumeration date
12/28/2006
Last updated
06/08/2015
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