BROADWAY PSYCHOTHERAPY, INC. (NPI# 1811162316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811162316 |
| Entity Type | Organization |
| Organization Name | BROADWAY PSYCHOTHERAPY, INC. |
| Other Organization Name | HEALTH BEHAVIOR CONSULTANTS, INC. |
| Practice Address |
347 Broadway Providence RI 02909-1101 |
| Practice Telephone | 4012709808 |
| Practice Fax Number | 4013547455 |
| Mailing Telephone | 4012709808 |
| Mailing Fax Number | 4013547455 |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2017-05-03 |
| Authorized Official Name | DR. JEFFREY P. MIGNEAULT (PRESIDENT) |
| Authorized Official Telephone | 4012709808 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1041C0700X |
Social Worker Specialization: Clinical |
ISW00174 | RI | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PS00585 | RI | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Health Behavior Consultants, Inc. | Former Legal Business Name - Organization |
| Street Address |
347 BROADWAY |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02909-1101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821185778 | Paula J Foster | Social Worker | 347 Broadway, Providence, RI 02902-0001 | 2006-10-10 |
| 1497028633 | Bree Elizabeth Derrick | Counselor | 347 Broadway, Providence, RI 02909-1101 | 2012-02-20 |
| 1295883965 | Jeffrey P Migneault | Psychologist | 347 Broadway, Providence, RI 02909-1101 | 2007-01-08 |
| 1174695167 | Pasquale Anthony Mastrostefano | Internal Medicine | 347 Broadway, Providence, RI 02909 | 2006-11-14 |
| 1982784674 | Ira H Reiter | Psychologist | 347 Broadway, Providence, RI 02909-1101 | 2006-10-17 |
| 1497844963 | Daniel Joseph Hurley Jr. | Psychologist | 347 Broadway, Providence, RI 02909 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578021754 | Roberta Bellas Portugal | Registered Nurse | Behave Care, 188 Valley St, Providence, RI 02909 | 2019-03-07 |
| 1912137324 | Catherine Elaine Tuttle | Social Worker | 623 Atwells Avenue, Suite 201, Providence, RI 02909 | 2009-07-20 |
| 1477736452 | City Dental, LLC | Dentist | 314f Pocasset Avenue, Providence, RI 02909 | 2007-12-12 |
| 1245449651 | Walter R. Vandyck | Occupational Therapist | Springfield Middle School, Providene School Department, 152 Springfield St, Providence, RI 02909 | 2007-05-22 |
| 1780805283 | Marcel A Trisvan | Counselor | Codac Providence, 349 Huntington Ave, Providence, RI 02909 | 2007-05-01 |
| 1215153945 | Codac Inc | Peer Specialist | 349 Huntington Ave, Codac Providence, Providence, RI 02909 | 2007-04-18 |
| 1316076342 | Mulak Chiropractic Center Inc | Chiropractor | 411 Broadway, Providence, RI 02909 | 2007-03-05 |
| 1710042742 | Michael Antonio Pensa | Chiropractor | 45 Eagle St Bld J Unit 100, Providence, RI 02909 | 2006-12-27 |
| 1780768234 | Providence Community Action | Case Management | 662 Hartford Avenue, Providence, RI 02909 | 2006-10-24 |
| 1881629608 | Cora Brigid Mayer | Counselor | 623 Atwells Ave., Communities for People, Inc., Providence, RI 02909 | 2006-07-11 |
| Find all providers in zip 02909 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982225033 | Julia Michelle Kamenetsky | Psychologist | 1155 Westminster St Ste 206, Providence, RI 02909-1140 | 2020-04-29 |
| 1801430509 | Concentric Psychological Services PC | Psychologist | 205 Waterman St Ste 106, Providence, RI 02906-4313 | 2019-11-05 |
| 1073094181 | Frederick Psychological Services, LLC | Psychologist | 2 Regency Plz Ste 18, Providence, RI 02903-3143 | 2018-08-27 |
| 1316453855 | Ellen Van Ingen Darling | Psychologist | 285 Governor St Ste 250, Providence, RI 02906 | 2017-12-20 |
| 1255865218 | Carly Michelle Goldstein | Psychologist | 196 Richmond St, Providence, RI 02903-4212 | 2017-04-17 |
| 1831505163 | Von Marie Rodriguez-guzman | Psychologist | Coro West Building, One Hoppin Street, Room 2.062, Providence, RI 02903 | 2014-07-08 |
| 1407262058 | Theresa Morgan | Psychologist | 593 Eddy St, Potter Bldg 2nd Floor, Dept of Psychiatry, Rhode Island Hospital, Providence, RI 02903 | 2014-07-03 |
| 1871930875 | Bernardine Pinto | Psychologist | 164 Summit Ave. Coro West, Suite 309, Miriam Hospital, Cbpm, Providence, RI 02906 | 2013-05-30 |
| 1619240009 | Shirley Yen | Psychologist | 700 Butler Dr, Providence, RI 02906-4871 | 2012-02-15 |
| 1639440449 | Sasha Lambert | Psychologist | 49 Pavilion Ave Ste 105, Providence, RI 02905-1534 | 2012-01-25 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02909 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.