Healthcare Provider Details

I. General information

NPI: 1982552899
Provider Name (Legal Business Name): VANGUARD PSYCHIATRY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DORRANCE ST STE 706
PROVIDENCE RI
02903-2014
US

IV. Provider business mailing address

10 DORRANCE ST STE 706
PROVIDENCE RI
02903-2014
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-4241
  • Fax: 401-804-0401
Mailing address:
  • Phone: 401-447-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MOZART TELLES
Title or Position: OWNER
Credential: PMHNP
Phone: 401-447-4241