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General NPI Number Information
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NPI Number | 1376368100
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Entity Type | Individual
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Provider Name | COURTNEY RUNKEL
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 122 W MAIN ST
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City | BABYLON
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State | NY
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Zip | 11702-3425
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Country | US
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Telephone | 631-482-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SHINNECOCK AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-6716
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Country | US
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Telephone | 516-655-0597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 125637
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License Number State | NY
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