Organization
ANNETTE PROVENCHER LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE PROVENCHER LCSW (OWNER)
(732) 876-3094
Entity
Organization
Contact information
Practice address
24 CHAPMAN TER, MIDDLETOWN, NJ 07748-1563
(732) 876-3094
Mailing address
39 AVENUE AT THE CMN, SUITE 106, SHREWSBURY, NJ 07702-4807
(732) 876-3094
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC04823100
NJ
Other
Enumeration date
03/11/2017
Last updated
03/11/2017
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