| 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 (9 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 CentersThis industry comprises establishments with medical staff primarily engaged in providing outpatient services related to the diagnosis and treatment of mental health disorders and alcohol and other substance abuse. These establishments generally treat patients who do not require inpatient treatment. They may provide a counseling staff and information regarding a wide range of mental health and substance abuse issues and/or refer patients to more extensive treatment programs, if necessary. Learn more at the U.S. Census Bureau
| 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
