Healthcare Provider Details

I. General information

NPI: 1396443164
Provider Name (Legal Business Name): SALT & LIGHT BEHAVIORAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 MENDON RD
WOONSOCKET RI
02895-6187
US

IV. Provider business mailing address

2345 MENDON RD STE 4
WOONSOCKET RI
02895-6164
US

V. Phone/Fax

Practice location:
  • Phone: 401-250-0123
  • Fax: 401-238-8769
Mailing address:
  • Phone: 401-250-0123
  • Fax: 401-238-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA LANGEVIN
Title or Position: DIRECTOR
Credential: PMHNP, BC
Phone: 401-250-0123