Provenzano, Richard J

Provenzano, Richard J is an sole proprietor health care provider with primary practice located at 227 S Main St , Woodstock VA 22664-1451. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Provenzano, Richard J can be contacted via phone (540) 335-3715.

Contact Information

Primary practice address
227 S Main St Woodstock VA 22664-1451
Phone: (540) 335-3715
Fax: (540) 459-9015
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 0904002158 Virginia

Profile Details

NPI number 1073605945
LBN Legal business name Provenzano, Richard J
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 29th, 2006
Last updated Oct 27th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1073605945 NPPES
Virginia Other 089598M OUTPATIENT THERAPY-OPTIMA
Virginia MEDICAID 010278520 OUTPATIENT THERAPY-OPTIMA
Virginia Other 197389 OUTPATIENT THERAPY-OPTIMA

Popular Providers