| Name: | Martha Dempster, LICSW, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 15 Jul 2004 (21 years ago) |
| Date of Dissolution: | 15 Jun 2009 (16 years ago) |
| Date of Status Change: | 15 Jun 2009 (16 years ago) |
| Identification Number: | 000141556 |
| ZIP code: | 02852 |
| County: | Washington County |
| Principal Address: | 1130 TEN ROD ROAD SUITE D 104, NORTH KINGSTOWN, RI, 02852, USA |
| Mailing Address: | 1130 TEN ROD RD D-104, NORTH KINGSTOWN, RI, 02852, USA |
| Purpose: | PSYCHOTHERAPY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073666913 | 2007-01-22 | 2020-08-22 | 1130 TEN ROD RD, SUITE D-104, NORTH KINGSTOWN, RI, 028524180, US | 1130 TEN ROD RD, SUITE D-104, NORTH KINGSTOWN, RI, 028524180, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-935-9784 |
| Fax | 4012955552 |
Authorized person
| Name | MS. MARTHA DEMPSTER |
| Role | OWNER |
| Phone | 4019359784 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ISW01537 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 301257 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH PLAN |
| Number | 1037150 |
| State | RI |
| Issuer | BLUE CHIP |
| Number | 409249 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| MARTHA DEMPSTER | Agent | 1130 TEN ROD ROAD SUITE D 104, NORTH KINGSTOWN, RI, 02852, USA |
| Number | Name | File Date |
|---|---|---|
| 200946450000 | Revocation Certificate For Failure to File the Annual Report for the Year | 2009-06-15 |
| 200944340790 | Revocation Notice For Failure to File An Annual Report | 2009-03-25 |
| 200701325730 | Annual Report | 2007-09-25 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
