MEDICARE: GROWING LIGHT PSYCHIATRY AND WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1174474365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING LIGHT PSYCHIATRY AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	1660 SOLDIERS FIELD RD STE 7-1030
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-1108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 SOLDIERS FIELD RD STE 7-1030
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-1108
Country	:	US
Telephone Number	:	617-924-6484
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	KRISTEN DOUCET
Credential	:
Telephone Number	:	781-214-1929

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	06/02/2026

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