Active NPI
Jacqueline Provenzano, LCSW
- Social Worker
- Centerville, MA
National Provider Identifier
1316411770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 000224420
- Practice address
- 1185 Falmouth Rd
Centerville, MA 02632-3066 - Phone
- (508) 862-9929
- NPI assigned
- Jan 17, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 000224420 | MA | Primary |
Addresses
Primary practice location
1185 Falmouth Rd
Centerville, MA 02632-3066
Mailing address
218 Little River Rd
Cotuit, MA 02635-2805
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000224420 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547683200000",
"number": "1316411770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 LITTLE RIVER RD",
"city": "COTUIT",
"state": "MA",
"postal_code": "026352805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1185 FALMOUTH RD",
"city": "CENTERVILLE",
"state": "MA",
"postal_code": "026323066",
"telephone_number": "508-862-9929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENZANO",
"first_name": "JACQUELINE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-17",
"last_updated": "2019-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "000224420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centerville, MA
- Ida Marie Perry
- Physical Therapy Solutions LLC (Physical Therapy Solutions)
- Physiotherapy Associates Inc (Physiotherapy Associates)
- Marlene Carol Pinskypanish
- Courtney Poignand, M.S.
- Ellen Louise Queeney, LICSW
- Sabrina Lira Ribeiro, NP, FNP
- Shelby Catherine Riley, MSW, LICSW
- Samuel Rosier, DPT
- Elizabeth A Santos, BA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.