Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Augustine Provencio, MS

Individual provider Clinical Child & Adolescent Psychologist · NPI 1629810270

Augustine Provencio, MS is a Clinical Child & Adolescent Psychologist in Los Angeles, California. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
2
What do these letters mean?
MS — Master of Science
A graduate science degree.

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Practice location Address checks out

4650 W Sunset Blvd # 53
Los Angeles, CA 90027-6062
Phone: (323) 361-3849
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X
Clinical Child & Adolescent Psychologist Taxonomy 103TC2200X

Record details

NPI number1629810270
Entity typeIndividual (Type 1)
GenderMale
Credentials MS
Sole proprietorYes
NPI enumeratedJune 12, 2024
Last updated in NPPESAugust 27, 2025
Certification dateAugust 27, 2025

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