Provider Demographics
NPI:1578328555
Name:JEANTY-BAZILE, RUTH-FIONA
Entity Type:Individual
Prefix:
First Name:RUTH-FIONA
Middle Name:
Last Name:JEANTY-BAZILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 FULLER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4255
Mailing Address - Country:US
Mailing Address - Phone:857-417-0368
Mailing Address - Fax:
Practice Address - Street 1:526 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2343
Practice Address - Country:US
Practice Address - Phone:617-477-4050
Practice Address - Fax:857-244-6299
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician