Individual
JACQUELINE PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1185 FALMOUTH RD, CENTERVILLE, MA 02632-3066
(508) 862-9929
Mailing address
218 LITTLE RIVER RD, COTUIT, MA 02635-2805
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
000224420
MA
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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