| Name: | Providence Behavioral Health Associates, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 14 Dec 2006 (18 years ago) |
| Identification Number: | 000160298 |
| ZIP code: | 02908 |
| County: | Providence County |
| Principal Address: | 1075 SMITH STREET, PROVIDENCE, RI, 02908-2700, USA |
| Purpose: | PSYCHOLOGICAL AND PSYCHIATRIC EVALUATION AND TREATMENT |
NAICS
621112 Offices of Physicians, Mental Health SpecialistsThis U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of psychiatry or psychoanalysis. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023142700 | 2007-03-15 | 2021-05-04 | 1075 SMITH ST, PROVIDENCE, RI, 029082700, US | 1075 SMITH ST, PROVIDENCE, RI, 029082700, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 401-369-9224 |
| Fax | 4013699275 |
Authorized person
| Name | DR. JOHN F. TODARO |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 4013699224 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS00948 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JOHN TODARO | Agent | 1075 SMITH STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| JOHN F. TODARO | PRESIDENT | 1075 SMITH STREET, 2ND FLOOR PROVIDENCE, RI 02908 USA |
| Name | Role | Address |
|---|---|---|
| JOHN TODARO | OTHER OFFICER | 1075 SMITH STREET PROVIDENCE, RI 02908-2700 USA |
| Number | Name | File Date |
|---|---|---|
| 202446433110 | Annual Report | 2024-02-15 |
| 202327427700 | Annual Report | 2023-02-03 |
| 202207764000 | Annual Report | 2022-01-10 |
| 202102915390 | Annual Report | 2021-10-08 |
| 202102914960 | Reinstatement | 2021-10-08 |
| 202199667880 | Revocation Certificate For Failure to File the Annual Report for the Year | 2021-07-29 |
| 202196844680 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202062529680 | Annual Report | 2020-10-08 |
| 202055052340 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201991063180 | Statement of Change of Registered Office by the Registered Agent | 2019-04-24 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6881707206 | 2020-04-28 | 0165 | PPP | 1075 SMITH ST, PROVIDENCE, RI, 02908-2700 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
