Healthcare Provider Details

I. General information

NPI: 1982118295
Provider Name (Legal Business Name): CANAAN PSYCHOTHERAPY INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 TOLL GATE RD
WARWICK RI
02886-2721
US

IV. Provider business mailing address

140 LAKE DR
WEST GREENWICH RI
02817-1563
US

V. Phone/Fax

Practice location:
  • Phone: 401-385-3936
  • Fax: 401-397-3488
Mailing address:
  • Phone: 401-338-3782
  • Fax: 401-397-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCAPRN00031
License Number StateRI

VIII. Authorized Official

Name: MRS. CYNTHIA P LONGWAY
Title or Position: PRESIDENT
Credential: APRN CNS
Phone: 401-338-3782