Provider Demographics
NPI:1720977069
Name:RUN, VANYA (CLINICAL INTERN)
Entity type:Individual
Prefix:
First Name:VANYA
Middle Name:
Last Name:RUN
Suffix:
Gender:F
Credentials:CLINICAL INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LEO AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4028
Mailing Address - Country:US
Mailing Address - Phone:978-905-9981
Mailing Address - Fax:
Practice Address - Street 1:101 JACKSON ST
Practice Address - Street 2:#4
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-459-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health