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General NPI Number Information
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NPI Number | 1013517341
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Entity Type | Individual
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Provider Name | ERICH BERANTUO CNP
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 26 QUEEN ST
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City | WORCESTER
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State | MA
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Zip | 01610-2473
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Country | US
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Telephone | 508-334-2670
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Fax | 508-334-2781
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Provider Business Mailing Address
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Address Line | PO BOX 415348
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN2284464
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN2284464
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN2284464
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 404793
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2284464
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License Number State | MA
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