Provider Demographics
NPI:1396443164
Name:SALT & LIGHT BEHAVIORAL HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:SALT & LIGHT BEHAVIORAL HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:401-250-0123
Mailing Address - Street 1:32 JONES ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-8136
Mailing Address - Country:US
Mailing Address - Phone:401-250-0123
Mailing Address - Fax:
Practice Address - Street 1:32 JONES ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-8136
Practice Address - Country:US
Practice Address - Phone:401-250-0123
Practice Address - Fax:949-404-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty