| Name: | GINA M. IACIOFANO, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 22 Apr 2012 (13 years ago) |
| Identification Number: | 000789755 |
| Principal Address: | 15 STONE FOREST LANE, ATTLEBORO, MA, 02703, USA |
| Purpose: | OUTPATIENT PSYCHOTHERAPY |
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 | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437417839 | 2012-04-24 | 2012-04-24 | 1920 MINERAL SPRING AVE, UNIT 9, NORTH PROVIDENCE, RI, 029043742, US | 1920 MINERAL SPRING AVE, UNIT 9, NORTH PROVIDENCE, RI, 029043742, US | |||||||||||||||||||||||||||||
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| Phone | +1 401-497-6500 |
Authorized person
| Name | GINA M IACIOFANO |
| Role | CLINICAL SOCIAL WORKER |
| Phone | 4014976500 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ISW02121 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 002186701 |
| State | RI |
| Issuer | MEDICAID |
| Number | GI84855 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| REGISTERED AGENTS INC. | Agent | 47 WOOD AVENUE SUITE 2, BARRINGTON, RI, 02806, USA |
| Number | Name | File Date |
|---|---|---|
| 202445601600 | Annual Report | 2024-02-05 |
| 202338626280 | Statement of Change of Registered/Resident Agent | 2023-06-23 |
| 202327393500 | Annual Report | 2023-02-03 |
| 202209827190 | Annual Report | 2022-02-09 |
| 202101050010 | Annual Report | 2021-09-08 |
| 202197178450 | Annual Report | 2021-05-24 |
| 202197178540 | Statement of Change of Registered/Resident Agent Office | 2021-05-24 |
| 202197178180 | Reinstatement | 2021-05-24 |
| 202190743970 | Miscellaneous Filing (No Fee) | 2021-01-27 |
| 202083009310 | Revocation Certificate For Failure to Maintain a Registered Office | 2020-12-30 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1885679000 | 2021-05-14 | 0165 | PPP | 372 Central Ave # 1, Pawtucket, RI, 02860-2325 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Oct 2024
Sources: Rhode Island Department of State
