Annette Provencher LCSW LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC04823100 Issued in NJ

Legal business name

ANNETTE PROVENCHER LCSW LLC

Practice address

24 Chapman Ter
Middletown, NJ 07748-1563

Phone

(732) 876-3094

NPI assigned

Mar 11, 2017

Organization subpart

No

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

Authorized official

Name

Annette Provencher, LCSWNPI 1972715738

Title

Owner

Phone

(732) 876-3094

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Annette Cecile Provencher, MSW LCSW

  • Clinical Social Worker
  • Red Bank, NJ
  • NPI 1972715738
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1489190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489190400000",
    "number": "1225579162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 AVENUE AT THE CMN",
            "address_2": "SUITE 106",
            "city": "SHREWSBURY",
            "state": "NJ",
            "postal_code": "077024807",
            "telephone_number": "732-876-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 CHAPMAN TER",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077481563",
            "telephone_number": "732-876-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNETTE PROVENCHER LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-11",
        "last_updated": "2017-03-11",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-876-3094",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC04823100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.