Healthcare Provider Details

I. General information

NPI: 1023704970
Provider Name (Legal Business Name): JUSTIN DELYANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUSTIN BEAUCAGE

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 517
WARWICK RI
02886-6100
US

IV. Provider business mailing address

400 BALD HILL RD STE 517
WARWICK RI
02886-6100
US

V. Phone/Fax

Practice location:
  • Phone: 866-802-8915
  • Fax:
Mailing address:
  • Phone: 866-802-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00906
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01829
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: