Healthcare Provider Details

I. General information

NPI: 1477136513
Provider Name (Legal Business Name): HEALING MINDS PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STATE AVE
TIVERTON RI
02878-1062
US

IV. Provider business mailing address

301 STATE AVE
TIVERTON RI
02878-1062
US

V. Phone/Fax

Practice location:
  • Phone: 774-300-3444
  • Fax: 774-307-9039
Mailing address:
  • Phone: 774-300-3444
  • Fax: 774-307-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIE DEJESUS
Title or Position: PROVIDER
Credential: PMHNP
Phone: 774-300-3444