Healthcare Provider Details

I. General information

NPI: 1336062397
Provider Name (Legal Business Name): BOLD STEPS OF RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 WATERMAN AVE
EAST PROVIDENCE RI
02914-1314
US

IV. Provider business mailing address

989 WATERMAN AVE
EAST PROVIDENCE RI
02914-1314
US

V. Phone/Fax

Practice location:
  • Phone: 603-315-1823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TESS TWISS
Title or Position: DIRECTOR
Credential:
Phone: 603-315-1823