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General NPI Number Information
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NPI Number | 1619428422
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSOCIATES OF WARWICK II, LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 889 CENTERVILLE RD
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City | WARWICK
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State | RI
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Zip | 02886-4342
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Country | US
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Telephone | 401-826-8875
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Fax | 401-823-9180
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Provider Business Mailing Address
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Address Line | 889 CENTERVILLE RD
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City | WARWICK
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State | RI
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Zip | 02886-4342
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Country | US
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Telephone | 401-826-8875
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Fax | 401-823-9180
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. BRADEN JOEPHSON
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Credential | PH.D.
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Telephone | 917-776-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW01666
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | LBA00074
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS01524
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License Number State | RI
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