Individual
MRS. KALLIE JEAN PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
32 TIMBER RIDGE DR, MILFORD, NH 03055-3331
(860) 575-9009
Mailing address
32 TIMBER RIDGE DR, MILFORD, NH 03055-3331
(860) 575-9009
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3065
NH
Other
Enumeration date
08/29/2023
Last updated
03/28/2024
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