Individual
ANTHONY PROVAZZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
24 FRONT ST, EXETER, NH 03833-2727
(603) 866-6269
Mailing address
24 FRONT ST, EXETER, NH 03833-2727
(603) 866-6269
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
465
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706655Y0NH01
BHN
NH
05
—
99003227
—
NH
Enumeration date
12/01/2006
Last updated
07/18/2007
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