Marisa Provenzano, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

128960 Issued in CA

Practice address

5060 Shoreham PL Ste 100
San Diego, CA 92122-5904

Phone

(877) 840-6956

NPI assigned

Jul 12, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sokyahealth Medical Group PCGroup PAC ID 8628463015, 180 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marisa.provenzano.p1@direct.sokya.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sokyahealth Medical Group PC

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1942970330

  Clinical

  Medicare reassignment Care Compare group NPD
• Headlight Health Medical Group PLLC

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1649064486
  NPD

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

{
    "created_epoch": "1752278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752278400000",
    "number": "1003707522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 RANCHO MIGUEL RD",
            "city": "JAMUL",
            "state": "CA",
            "postal_code": "919351907",
            "telephone_number": "619-847-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 SHOREHAM PL STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225904",
            "telephone_number": "877-840-6956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "MARISA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-12",
        "last_updated": "2025-07-12",
        "certification_date": "2025-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "128960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Kendall Provan
• Jenessa Rae Provence
• Sara Provence
• Christine Marie Provencher
• Paul Louis Provencio
• Brooke Proverb
• Provident Home Health Care, Inc.
• Caitlin Reese Suarez Provido
• Provision Pharmacy, Inc.
• Provision Pharmacy, Inc. -LTC

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.