| Doctor Name: | JONATHAN SCOTT RUNGE |
| NPI Number: | 1689730665 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 23772 |
| Business Practice Address: | 30 Conwell St Provincetown, MA - 026571548 |
| Business Phone Number: | 6179011196 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1861, PROVINCETOWN |
| State: | MA |
| Postal Code: | 026570245 |
| Phone Number: | 6179011196 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 06/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 23772 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |