NPIMap

Organization Active NPI

Center for Dynamic and Behavioral Therapy LLC

Doing business as PVD Psychological Associates

  • Clinical Psychologist
  • Providence, RI
National Provider Identifier
1790207876
Registry record updated Jul 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS01616 Issued in RI
Legal business name
CENTER FOR DYNAMIC AND BEHAVIORAL THERAPY LLC
Doing business as
PVD Psychological Associates
Practice address
382 Thayer St
Providence, RI 02906-1558
Phone
(401) 330-5882
Fax
(401) 226-0137
NPI assigned
Jul 11, 2017
Last updated
Jul 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicole Issa, PSYDNPI 1154458438
Title
Owner
Phone
(401) 330-5882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS01616 RI Primary
Clinical Psychologist 103TC0700X PS01615 RI

Addresses

Primary practice location

382 Thayer St
Providence, RI 02906-1558

Mailing address

11 S Angell St # 405
Providence, RI 02906-5206
Phone (401) 330-5882

Other practice location 1

150 Lloyd Ave # 1
Providence, RI 02906-1553
Phone (401) 330-5882

Other names 1

  • PVD Psychological Associates Doing business as

National Provider Directory

National Provider Directory

Locations

150 Lloyd Ave
#1
Providence, RI 02906
Phone (401) 330-5882

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627171200000",
    "number": "1790207876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S ANGELL ST # 405",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065206",
            "telephone_number": "401-330-5882",
            "fax_number": "401-226-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 THAYER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029061558",
            "telephone_number": "401-330-5882",
            "fax_number": "401-226-0137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Lloyd Ave # 1",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029061553",
            "country_code": "US",
            "telephone_number": "401-330-5882",
            "fax_number": "401-226-0137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR DYNAMIC AND BEHAVIORAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-11",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A",
        "authorized_official_last_name": "ISSA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-330-5882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01616",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01615",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PVD Psychological Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.