Individual
KATIE PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
15 UNION STREET, MILFORD, NH 03055
(603) 271-5402
Mailing address
15 UNION STREET, MILFORD, NH 03055
(603) 493-5132
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1649
NH
Other
Enumeration date
04/29/2014
Last updated
03/07/2017
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