Provider Demographics
NPI:1033522669
Name:BRIAN'S T.E.A.M. LLC
Entity Type:Organization
Organization Name:BRIAN'S T.E.A.M. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:973-628-0400
Mailing Address - Street 1:22 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3115
Mailing Address - Country:US
Mailing Address - Phone:973-628-0400
Mailing Address - Fax:973-627-1724
Practice Address - Street 1:22 RIVERVIEW DR
Practice Address - Street 2:C/O BRIAN'S T.E.A.M.
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3115
Practice Address - Country:US
Practice Address - Phone:973-628-0400
Practice Address - Fax:973-627-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00470500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty