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NPI Code Detail

MEDICARE: MS. CHRISTINE NICOLE RUNYAN PH.D.

MEDICARE: MS. CHRISTINE NICOLE RUNYAN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist1133NH
2103TC0700XClinical PsychologistPSY.0004808CO
3103T00000XPsychologist205032795MO
4103TC0700XClinical Psychologist9111MA

General Provider Information

NPI Number : 1134237787
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE NICOLE RUNYAN PH.D.
Provider Business Mailing Address
First Line : PO BOX 110429
Second Line :
City : AURORA
State : CO
Zip : 80042-0429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 774-441-6225
Fax Number : 508-334-8835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 06/03/2026

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