Provider Demographics
NPI:1366763823
Name:PROVENCAL, SHEILA ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANN
Last Name:PROVENCAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 13
Mailing Address - Street 2:201 SCHOOL STREET
Mailing Address - City:FORESTDALE
Mailing Address - State:RI
Mailing Address - Zip Code:02824
Mailing Address - Country:US
Mailing Address - Phone:401-257-5628
Mailing Address - Fax:
Practice Address - Street 1:201 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:RI
Practice Address - Zip Code:02824
Practice Address - Country:US
Practice Address - Phone:401-257-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist