| 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 Specialists |
| 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 | |||||||||||||||||||
|
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| 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 |
Date of last update: 10 Oct 2024
Sources: Rhode Island Department of State
