Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kayla Marie Brock-Provencher, CSW

Individual provider Clinical Social Worker · NPI 1922782507

Kayla Marie Brock-Provencher, CSW is a Clinical Social Worker in Louisville, Kentucky. Qualified in 2023, 3 years ago. Practices with Brock Family Therapy Center Inc, a 12-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
3
Licensed in
KY
In the registry since
2023
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Practice location Address checks out

10300 Brookridge Village Blvd Ste 104
Louisville, KY 40291-4474
Phone: (502) 785-4322
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 258016 (KY)

Record details

NPI number1922782507
Entity typeIndividual (Type 1)
GenderFemale
Credentials CSW
Sole proprietorNo
NPI enumeratedJune 14, 2023
Last updated in NPPESJune 14, 2023
Certification dateJune 5, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Brock Family Therapy Center Inc. — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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