Healthcare Provider Details

I. General information

NPI: 1164352431
Provider Name (Legal Business Name): VIVAPATH BEHAVIORAL AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DORRANCE ST STE 700
PROVIDENCE RI
02903-2014
US

IV. Provider business mailing address

72 SHADY HILL DR
WEST WARWICK RI
02893-2337
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-2906
  • Fax: 401-895-3771
Mailing address:
  • Phone: 401-829-2906
  • Fax: 401-895-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLARIBEL CRUZ
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 401-829-2906