Healthcare Provider Details

I. General information

NPI: 1619428422
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSOCIATES OF WARWICK II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 CENTERVILLE RD
WARWICK RI
02886-4342
US

IV. Provider business mailing address

889 CENTERVILLE RD
WARWICK RI
02886-4342
US

V. Phone/Fax

Practice location:
  • Phone: 401-826-8875
  • Fax: 401-823-9180
Mailing address:
  • Phone: 401-826-8875
  • Fax: 401-823-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01666
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLBA00074
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01524
License Number StateRI

VIII. Authorized Official

Name: DR. BRADEN JOEPHSON
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 917-776-5433