Active NPI
Sherri Lynn Provencal, PH.D.
- Clinical Neuropsychologist
- Pawtucket, RI
National Provider Identifier
1245477785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PS01063
- Practice address
- 555 Prospect St
Pawtucket, RI 02860-6200 - Phone
- (401) 729-6200
- Fax
- (401) 729-6203
- NPI assigned
- Jan 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS01063 | RI | Primary |
Addresses
Primary practice location
555 Prospect St
Pawtucket, RI 02860-6200
Mailing address
555 Prospect St
Pawtucket, RI 02860-6200
Phone (401) 729-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS01063 | RI | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279152000000",
"number": "1245477785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 PROSPECT ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028606200",
"telephone_number": "401-729-6200",
"fax_number": "401-729-6203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 PROSPECT ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028606200",
"telephone_number": "401-729-6200",
"fax_number": "401-729-6203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENCAL",
"first_name": "SHERRI",
"middle_name": "LYNN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-20",
"last_updated": "2010-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "RI",
"license": "PS01063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.