Provider Demographics
NPI:1487814976
Name:KREMENTZ, BARBARA M (MSW LICSW ATR)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:KREMENTZ
Suffix:
Gender:F
Credentials:MSW LICSW ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-0407
Mailing Address - Country:US
Mailing Address - Phone:401-484-1841
Mailing Address - Fax:206-457-1819
Practice Address - Street 1:203 GOVERNOR STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-484-1841
Practice Address - Fax:206-457-1819
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0739071104100000X
MA1143531041C0700X
RIISW018981041C0700X
NJ44SC053066001041C0700X
CT58.0074071041C0700X
MELC117811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD40002767Medicare PIN