Individual
MISS JEAN LOUISE PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
807 CRANBURY CROSS RD, NORTH BRUNSWICK, NJ 08902-2268
(908) 510-0532
Mailing address
807 CRANBURY CROSS RD, NORTH BRUNSWICK, NJ 08902-2268
(908) 510-0532
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
077689-1
NY
104100000X
Social Worker
44SL055245000
NJ
1041C0700X
Clinical Social Worker
Primary
44SC05473500
NJ
Other
Enumeration date
11/17/2008
Last updated
10/18/2022
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