Healthcare Provider Details

I. General information

NPI: 1801447073
Provider Name (Legal Business Name): CHRISTOPHER LOUIE FAXAS-CRUZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date: 07/11/2025
Reactivation Date: 08/09/2025

III. Provider practice location address

50 HEALTH LN
WARWICK RI
02886-2711
US

IV. Provider business mailing address

50 HEALTH LN
WARWICK RI
02886-2711
US

V. Phone/Fax

Practice location:
  • Phone: 401-691-6000
  • Fax: 401-738-8634
Mailing address:
  • Phone: 401-691-6000
  • Fax: 401-738-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04181
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: