| Name: | PSYCHOLOGICAL ASSOCIATES OF WARWICK II, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 27 Sep 2016 (8 years ago) |
| Date of Dissolution: | 22 Jul 2019 (6 years ago) |
| Date of Status Change: | 22 Jul 2019 (6 years ago) |
| Identification Number: | 001667054 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 889 CENTERVILLE ROAD, WARWICK, RI, 02886, USA |
| Mailing Address: | 3327 80TH STREET SPT 42, JACKSON HEIGHTS, NY, 11372, USA |
| Purpose: | PSYCHOLOGICAL HEALTH CARE |
| NAICS: | 621420 - Outpatient Mental Health and Substance Abuse Centers |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619428422 | 2016-10-17 | 2016-10-17 | 889 CENTERVILLE RD, WARWICK, RI, 028864342, US | 889 CENTERVILLE RD, WARWICK, RI, 028864342, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 401-826-8875 |
| Fax | 4018239180 |
Authorized person
| Name | DR. BRADEN JOEPHSON |
| Role | OWNER/PSYCHOLOGIST |
| Phone | 9177765433 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS01524 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | ISW01666 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 106E00000X - Assistant Behavior Analyst |
| License Number | LBA00074 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS AND BLUE SHIELD OF RI |
| Number | 0000003916 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH BEACON HEALTH OPTIONS |
| Number | 1101520 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| THOMAS C. PLUNKETT, ESQ. | Agent | 146 WESTMINSTER STREET 5TH FLOOR, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| BRADEN JOSEPHSON PH.D | MANAGER | 3327 80TH STREET, SPT 42 JACKSON HEIGHTS, NY 11372 USA |
| Number | Name | File Date |
|---|---|---|
| 201906467890 | Revocation Certificate For Failure to File the Annual Report for the Year | 2019-07-22 |
| 201992389090 | Revocation Notice For Failure to File An Annual Report | 2019-05-13 |
| 201860189890 | Annual Report | 2018-03-14 |
| 201857590430 | Statement of Change of Registered/Resident Agent Office | 2018-02-05 |
| 201609479000 | Articles of Organization | 2016-09-27 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
