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

Marisa Provenzano, LCSW

Individual provider Clinical Social Worker · NPI 1003707522

Marisa Provenzano, LCSW is a Clinical Social Worker in San Diego, California. Qualified in 2021, 5 years ago. Practices with Sokyahealth Medical Group PC, a 178-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
5
Licensed in
CA
In the registry since
2025
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

5060 Shoreham Pl Ste 100
San Diego, CA 92122-5904
Phone: (877) 840-6956
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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 128960 (CA)

Record details

NPI number1003707522
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedJuly 12, 2025
Last updated in NPPESJuly 12, 2025
Certification dateJuly 12, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Sokyahealth Medical Group Pc — 178 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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