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General NPI Number Information
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NPI Number | 1225983810
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Entity Type | Organization
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Legal Business Name | GROW BOLD PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/28/2026
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Last Update Date | 03/08/2026
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Provider Practice Location Address
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Address Line | 130 DEWEY AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-2140
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Country | US
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Telephone | 401-787-5475
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Fax |
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Provider Business Mailing Address
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Address Line | 130 DEWEY AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-2140
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Country | US
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Telephone | 401-787-5475
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. WENDY ANNE OSSMAN
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Credential | PSY.D.
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Telephone | 401-787-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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