Individual
JANELLE KIRA PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
10 CABOT RD, MEDFORD, MA 02155-5177
(617) 312-7294
(781) 395-0198
Mailing address
10 CABOT RD, MEDFORD, MA 02155-5177
(617) 312-7294
(781) 395-0198
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/08/2009
Last updated
09/23/2010
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