Healthcare Provider Details

I. General information

NPI: 1487062907
Provider Name (Legal Business Name): BETH CLEARY PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893
US

IV. Provider business mailing address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-2800
  • Fax:
Mailing address:
  • Phone: 401-615-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2264984
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN01978
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2264984
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: