Individual
ANNETTE CECILE PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
210 BROAD ST, RED BANK, NJ 07701-2060
(732) 876-3094
(732) 615-2359
Mailing address
24 CHAPMAN TER, MIDDLETOWN, NJ 07748-1563
(732) 615-2359
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC04823100
NJ
Other
Enumeration date
05/04/2007
Last updated
11/04/2024
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