MEDICARE: GROW BOLD PSYCHOTHERAPY

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1225983810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW BOLD PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	130 DEWEY AVE
Second Line	:
City	:	EAST PROVIDENCE
State	:	RI
Zip	:	02914-2140
Country	:	US
Telephone Number	:	401-787-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 TEN ROD RD STE E206
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4168
Country	:	US
Telephone Number	:	401-787-5475
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. WENDY ANNE OSSMAN
Credential	:	PSY.D.
Telephone Number	:	401-787-5475

Provider Enumeration Date	:	02/28/2026
Last Update Date	:	03/24/2026

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