| Annette Provencher Lcsw Llc | |
|
24 Chapman Ter Middletown NJ 07748-1563 | |
| (732) 876-3094 | |
| Not Available |
| Full Name | Annette Provencher Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 24 Chapman Ter, Middletown, New Jersey |
| Authorized Official Name and Position | Annette Provencher (OWNER) |
| Authorized Official Contact | 7328763094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Annette Provencher Lcsw Llc 39 Avenue At The Cmn Suite 106 Shrewsbury NJ 07702-4807 Ph: (732) 876-3094 | Annette Provencher Lcsw Llc 24 Chapman Ter Middletown NJ 07748-1563 Ph: (732) 876-3094 |
| NPI Number | 1225579162 |
|---|---|
| Provider Enumeration Date | 03/11/2017 |
| Last Update Date | 03/11/2017 |
| Medicare PECOS PAC ID | 3274804539 |
|---|---|
| Medicare Enrollment ID | O20170803003647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225579162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC04823100 (New Jersey) | Primary |
| Provider Name | Annette C Provencher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972715738 PECOS PAC ID: 7214975721 Enrollment ID: I20050425000240 |
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