| Name: | Braver Medical, PLLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 18 Aug 2021 (4 years ago) |
| Branch of: | Braver Medical, PLLC, CONNECTICUT (Company Number 2327260) |
| Identification Number: | 001728300 |
| ZIP code: | 02806 |
| County: | Bristol County |
| Place of Formation: | CONNECTICUT |
| Principal Address: | 67 BAY ROAD, BARRINGTON, RI, 02806, USA |
| Mailing Address: | 51 STANDISH RD, WELLESLEY, MA, 02481, USA |
| Purpose: | BEHAVIORAL HEALTH THERAPY FOR CHILDREN WITH ANXIETY. |
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 | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972265536 | 2021-10-12 | 2022-11-20 | 67 BAY RD, BARRINGTON, RI, 028064751, US | 1275 WAMPANOAG TRL STE 3C, RIVERSIDE, RI, 029151217, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 917-697-2890 |
| Fax | 4019032192 |
| Phone | +1 401-206-0304 |
| Fax | 4013436466 |
Authorized person
| Name | BRADY CASE |
| Role | MEMBER |
| Phone | 9176972890 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TC2200X - Clinical Child & Adolescent Psychologist |
| Is Primary | No |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PSYCHOLOGIST LICENSE |
| Number | PS01333 |
| State | RI |
| Issuer | PSYCHOLOGIST LICENSE |
| Number | PS00846 |
| State | RI |
| Issuer | MEDICAL LICENSE |
| Number | MD12323 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| NATIONAL REGISTERED AGENTS, INC. | Agent | 450 VETERANS MEMORIAL PARKWAY SUITE 7A, EAST PROVIDENCE, RI, 02914, USA |
| Number | Name | File Date |
|---|---|---|
| 202450533660 | Annual Report | 2024-04-09 |
| 202332142560 | Annual Report | 2023-03-31 |
| 202222917360 | Annual Report | 2022-09-20 |
| 202219243500 | Revocation Notice For Failure to File An Annual Report | 2022-06-22 |
| 202100228140 | Application for Registration | 2021-08-18 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
