Individual
PEYTON RYLEY PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 CONSTITUTION WAY STE 6, WOBURN, MA 01801-1199
(888) 754-0398
Mailing address
10 HOMER SQ, SOMERVILLE, MA 02143-3003
(207) 835-9007
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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