Provider Demographics
NPI:1982118295
Name:CANAAN PSYCHOTHERAPY INC,
Entity Type:Organization
Organization Name:CANAAN PSYCHOTHERAPY INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LONGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNS
Authorized Official - Phone:401-338-3782
Mailing Address - Street 1:140 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1563
Mailing Address - Country:US
Mailing Address - Phone:401-338-3782
Mailing Address - Fax:401-397-3488
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-596-6866
Practice Address - Fax:401-397-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICAPRN00031364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1861447831OtherOPTUM
RIBNP001353OtherBEACON HEALTH OPTIONS
RI1861447831OtherBCBSRI