Provider Demographics
NPI:1134627854
Name:JANTZ, BRIAN STEPHEN (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:STEPHEN
Last Name:JANTZ
Suffix:
Gender:M
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PINE CONE DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-2222
Mailing Address - Country:US
Mailing Address - Phone:617-448-1186
Mailing Address - Fax:
Practice Address - Street 1:25 W INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1126
Practice Address - Country:US
Practice Address - Phone:401-783-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMUS00010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist