Individual
MS. MONIQUE NELLIE PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
430 N PILGRIM ST, STOCKTON, CA 95205-4428
(000) 000-0000
Mailing address
430 N PILGRIM ST, STOCKTON, CA 95205-4428
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
150.118978
IL
1041C0700X
Clinical Social Worker
Primary
ASW136999
CA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/10/2015
Last updated
02/11/2026
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