Healthcare Provider Details

I. General information

NPI: 1134627854
Provider Name (Legal Business Name): BRIAN STEPHEN JANTZ MA, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W INDEPENDENCE WAY
KINGSTON RI
02881-1126
US

IV. Provider business mailing address

18 PINE CONE DR
BARRINGTON RI
02806-2222
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-4810
  • Fax:
Mailing address:
  • Phone: 617-448-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberMUS00010
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: