Provider Demographics
NPI:1619428422
Name:PSYCHOLOGICAL ASSOCIATES OF WARWICK II, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF WARWICK II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOEPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-776-5433
Mailing Address - Street 1:889 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4342
Mailing Address - Country:US
Mailing Address - Phone:401-826-8875
Mailing Address - Fax:401-823-9180
Practice Address - Street 1:889 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4342
Practice Address - Country:US
Practice Address - Phone:401-826-8875
Practice Address - Fax:401-823-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01524103TC0700X
RIISW016661041C0700X
RILBA00074106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000003916OtherBLUE CROSS AND BLUE SHIELD OF RI
RI1101520OtherNEIGHBORHOOD HEALTH BEACON HEALTH OPTIONS