| 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 |
| Fictitious names: |
Pvd Psych (trading name, 2018-04-06 - ) Pvd Psychological Associates (trading name, 2018-04-06 - ) CDBT Psych (trading name, 2017-05-24 - ) |
NAICS
621330 Offices of Mental Health Practitioners (except Physicians)This industry comprises establishments of independent mental health practitioners (except physicians) primarily engaged in (1) the diagnosis and treatment of mental, emotional, and behavioral disorders and/or (2) the diagnosis and treatment of individual or group social dysfunction brought about by such causes as mental illness, alcohol and substance abuse, physical and emotional trauma, or stress. 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 | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790207876 | 2017-07-11 | 2021-07-25 | 11 S ANGELL ST # 405, PROVIDENCE, RI, 029065206, US | 382 THAYER ST, PROVIDENCE, RI, 029061558, US | |||||||||||||||||||||||||||
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| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7161117703 | 2020-05-01 | 0165 | PPP | 150 LLOYD AVE # 1, PROVIDENCE, RI, 02906-1553 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
