Nicole Provencher, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMHC10001085 Issued in MA

Practice address

675 Main St
Waltham, MA 02451-0602

Phone

(781) 893-5110

NPI assigned

Jul 31, 2024

Last updated

Jul 31, 2024By the provider in NPPES

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 MA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Advocates, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Marlborough, MA
  • NPI 1437451382
  Medicare reassignment NPD
• Advocates, Inc

  dba Family Continuity

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Whitinsville, MA
  • NPI 1184478000
  NPD

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1083443626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 WINTHROP ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024721909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024510602",
            "telephone_number": "781-893-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "NICOLE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC10001085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prime Home Care Inc
• Sarah Prime
• Doris C Prince, P.T.
• Private Health Hub LLC
• Pro Sports Therapy, Inc.
• Provo Kidney Care LLC
• Aimee Jeanne Ptak, D.P.T.
• Jason Pugatch, LICSW
• Pure Motion PT
• Putnoi Eye Care, P.C.

• Mental Health Counselor in Waltham, MA
• Providers in Waltham, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.