Healthcare Provider Details

I. General information

NPI: 1366397937
Provider Name (Legal Business Name): ROOTS TO ROADS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 VALLEY ST BLDG 6M C/O SPROUT COWORKING LLC
PROVIDENCE RI
02909-2400
US

IV. Provider business mailing address

166 VALLEY ST BLDG 6M
PROVIDENCE RI
02909-2400
US

V. Phone/Fax

Practice location:
  • Phone: 401-297-0502
  • Fax: 401-297-0504
Mailing address:
  • Phone: 401-297-0502
  • Fax: 401-297-0504

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: LAUREN CUSHING
Title or Position: PMHNP
Credential: CNP
Phone: 401-297-0502