Provider Demographics
NPI:1710208277
Name:KRANTZ, GORDON
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GARDEN RD APT G
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3039
Mailing Address - Country:US
Mailing Address - Phone:207-615-3700
Mailing Address - Fax:
Practice Address - Street 1:217 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3728
Practice Address - Country:US
Practice Address - Phone:207-615-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker