Healthcare Provider Details

I. General information

NPI: 1992628812
Provider Name (Legal Business Name): BLUE HAVEN MENTAL HEALTH L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NARRAGANSETT PARK DR # 100
PAWTUCKET RI
02861-4326
US

IV. Provider business mailing address

700 NARRAGANSETT PARK DR # 100
PAWTUCKET RI
02861-4326
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-7296
  • Fax:
Mailing address:
  • Phone: 401-349-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA MCGUIRE
Title or Position: OWNER
Credential: LICSW
Phone: 401-349-7296