Provider Demographics
NPI:1780732164
Name:KRANTZ, ERIC M (LCSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WYNMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9182
Mailing Address - Country:US
Mailing Address - Phone:207-885-9188
Mailing Address - Fax:
Practice Address - Street 1:605 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9617
Practice Address - Country:US
Practice Address - Phone:207-885-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEKRMM3213Medicare ID - Type Unspecified