Mary Ellen Provencher, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

100755 Issued in MA

Practice address

789 Capboardtree St
Harbor Counseling Center
Westwood, MA 02090

Phone

(781) 234-1318

NPI assigned

Nov 15, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669544235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 CLEAR POND DRIVE",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020814310",
            "telephone_number": "508-660-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CAPBOARDTREE ST",
            "address_2": "HARBOR COUNSELING CENTER",
            "city": "WESTWOOD",
            "state": "MA",
            "postal_code": "02090",
            "telephone_number": "781-234-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "100755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elissa Shore Pototsky, LICSW
• Premium Eye Care, PC
• Cathleen Price, CRNA
• Benjamin Prieur, CRNA
• Anthony J Procopio, CRNA
• Keith William Provost, PHARMD
• Stephen Punzak, MD
• Thomas E Purcell, MD
• Christine Quinn, LMHC
• Dawn Quinn

• Clinical Social Worker in Westwood, MA
• Providers in Westwood, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.