| Name: | Center for Dynamic and Behavioral Therapy, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 17 May 2017 (8 years ago) |
| Identification Number: | 001673876 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 11 SOUTH ANGELL ST. #405, PROVIDENCE, RI, 02906, USA |
| Purpose: | TO PROVIDE PSYCHOLOGICAL SERVICES |
| NAICS: | 621330 - Offices of Mental Health Practitioners (except Physicians) |
| Fictitious names: |
Pvd Psych (trading name, 2018-04-06 - ) Pvd Psychological Associates (trading name, 2018-04-06 - ) CDBT Psych (trading name, 2017-05-24 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790207876 | 2017-07-11 | 2021-07-25 | 11 S ANGELL ST # 405, PROVIDENCE, RI, 029065206, US | 382 THAYER ST, PROVIDENCE, RI, 029061558, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 401-330-5882 |
| Fax | 4012260137 |
Authorized person
| Name | DR. NICOLE ISSA |
| Role | OWNER |
| Phone | 4013305882 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS01616 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS01615 |
| State | RI |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| STEPHEN D. ZUBIAGO, ESQ. | Agent | NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA |
| Number | Name | File Date |
|---|---|---|
| 202449929070 | Annual Report | 2024-04-01 |
| 202330273950 | Annual Report | 2023-03-07 |
| 202214238600 | Annual Report | 2022-04-04 |
| 202107129440 | Annual Report | 2021-12-15 |
| 202106601190 | Revocation Notice For Failure to File An Annual Report | 2021-12-03 |
| 202066919900 | Annual Report | 2020-10-21 |
| 201925118030 | Annual Report | 2019-10-21 |
| 201882197860 | Annual Report | 2018-12-03 |
| 201861707750 | Fictitious Business Name Statement | 2018-04-06 |
| 201861707110 | Fictitious Business Name Statement | 2018-04-06 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
