Healthcare Provider Details

I. General information

NPI: 1902715915
Provider Name (Legal Business Name): EDGE BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WILD ROSE CT
WAKEFIELD RI
02879-5480
US

IV. Provider business mailing address

14 WILD ROSE CT
WAKEFIELD RI
02879-5480
US

V. Phone/Fax

Practice location:
  • Phone: 401-445-4676
  • Fax:
Mailing address:
  • Phone: 401-445-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYSON JOHN SPAS
Title or Position: OWNER
Credential:
Phone: 401-445-4676