Healthcare Provider Details

I. General information

NPI: 1518861343
Provider Name (Legal Business Name): RENEW MIND PSYCHIATRY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 GOVERNOR ST
PROVIDENCE RI
02906-3124
US

IV. Provider business mailing address

189 GOVERNOR ST
PROVIDENCE RI
02906-3124
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-7098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PORTIA SALTIBUS
Title or Position: MANAGING MEMBER
Credential: MSN, APRN-CNP, PMHNP
Phone: 401-500-7098