Shayna Provencher, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13552 Issued in CT

Practice address

164 Hempstead St
New London, CT 06320-5638

Phone

(860) 237-3273

NPI assigned

Feb 8, 2023

Sex

Female

Sole proprietor

Yes

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

Enrolled in CT

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

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Chaise Lounge Counseling LLC

  • Community/Behavioral Health Agency
  • New London, CT
  • NPI 1477362168

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Reliance Health, Inc

  • Case Management Agency
  • Norwich, CT
  • NPI 1518198597
  NPD (past)
• Reliance Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norwich, CT
  • NPI 1578855508

  Clinical

  NPD (past)

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1801593199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PLAZA CT PO BOX 661",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063405702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063205638",
            "telephone_number": "860-237-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "SHAYNA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-08",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "13552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristian Pretashi, PHARMD
• Romana Primus, MD
• Keri Pringer, MSW, LMSW
• Edith M Prisloe, MSW
• Professional Endodontics LL
• Danielle Provoncha, CRNA
• Proyecto El Parto, Inc.
• Psychiatric Medicine Center PC
• Psychiatric Medicine Center, PC
• Psychiatric Medicine Center, PC

• Clinical Social Worker in New London, CT
• Providers in New London, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.