| Name: | Broadway Psychotherapy, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 13 Dec 2000 (24 years ago) |
| Identification Number: | 000115729 |
| ZIP code: | 02909 |
| County: | Providence County |
| Principal Address: | 433 BROADWAY 2ND FL, PROVIDENCE, RI, 02909, USA |
| Purpose: | TO PROVIDE PSYCHOTHERAPY SERVICES TO PATIENTS AND SUPERVISION TO OTHER CLINICIANS. TO PROVIDE BEHAVIORAL SCIENCE CONSULTING SERVICES TO BUSINESSES. |
| NAICS: | 621420 - Outpatient Mental Health and Substance Abuse Centers |
| Fictitious names: |
Health Behavior Consultants (trading name, 2017-08-08 - ) |
| Historical names: |
Health Behavior Consultants, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811162316 | 2008-04-25 | 2017-05-03 | 347 BROADWAY, PROVIDENCE, RI, 029091101, US | 347 BROADWAY, PROVIDENCE, RI, 029091101, US | |||||||||||||||||||||||||||
|
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| Phone | +1 401-270-9808 |
| Fax | 4013547455 |
Authorized person
| Name | DR. JEFFREY P. MIGNEAULT |
| Role | PRESIDENT |
| Phone | 4012709808 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS00585 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | ISW00174 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JEFFREY MIGNEAULT | Agent | 35 STEERE ROAD, GREENVILLE, RI, 02828, USA |
| Name | Role | Address |
|---|---|---|
| JEFFREY MIGNEAULT | PRESIDENT | 433 BROADWAY PROVIDENCE, RI 02909 USA |
| Name | Role | Address |
|---|---|---|
| SARAH TORREY | VICE PRESIDENT | 433 BROADWAY PROVIDENCE, RI 02909 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2017-05-01 | Health Behavior Consultants, Inc. | Broadway Psychotherapy, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202455060710 | Annual Report | 2024-05-30 |
| 202338828350 | Annual Report | 2023-06-28 |
| 202338049250 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202212680320 | Annual Report | 2022-03-12 |
| 202191591390 | Annual Report | 2021-02-17 |
| 202035890290 | Annual Report | 2020-03-04 |
| 201988783020 | Annual Report | 2019-03-18 |
| 201858899460 | Annual Report | 2018-02-23 |
| 201748289300 | Fictitious Business Name Statement | 2017-08-08 |
| 201742355290 | Articles of Amendment | 2017-05-01 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
