Provider Demographics
NPI:1134602394
Name:RUNYON, R ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:R
Middle Name:ELLEN
Last Name:RUNYON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W MAIN ST STE 5-264
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2487
Mailing Address - Country:US
Mailing Address - Phone:973-876-1536
Mailing Address - Fax:
Practice Address - Street 1:2 TREE FARM RD STE A220
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1487
Practice Address - Country:US
Practice Address - Phone:609-613-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058117001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical