Jennafer Rochelle Provinse

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

117856 Issued in CA

Practice address

15720 Ventura Blvd Ste 420
Encino, CA 91436-4711

Phone

(562) 449-9258

NPI assigned

Sep 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

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

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 and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846
  Medicare reassignment NPD

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1346558772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 E WILLOW ST # 169",
            "city": "SIGNAL HILL",
            "state": "CA",
            "postal_code": "907552148",
            "telephone_number": "562-449-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15720 VENTURA BLVD STE 420",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914364711",
            "telephone_number": "562-449-9258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Wilshire Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900171908",
            "country_code": "US",
            "telephone_number": "213-481-7464",
            "fax_number": "213-481-7147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2201 E Willow St # 169",
            "address_purpose": "LOCATION",
            "city": "Signal Hill",
            "state": "CA",
            "postal_code": "907552148",
            "country_code": "US",
            "telephone_number": "562-449-9258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVINSE",
        "first_name": "JENNAFER",
        "middle_name": "ROCHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-20",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "117856",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "82093",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "82093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pro Health Surgery Center
• Professional Care Hospice
• Promed Medical Supplies
• Jeffrey Proniloff, DDS
• Proper Care Home Health
• Pry, Inc
• Andre Prystupa
• Frizette Dodson Pua
• Shirley Puac
• Pulsepoint Management LLC

• Clinical Social Worker in Encino, CA
• Providers in Encino, 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 Oct 11, 2023; 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.