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

MS. Sean E Provencio

Individual provider Clinical Social Worker · NPI 1083508857

MS. Sean E Provencio is a Clinical Social Worker in Pasadena, California. Qualified in 2020, 6 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2025
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Practice location Address checks out

617 S Hudson Ave
Pasadena, CA 91106-3909
Phone: (626) 808-5784
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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 ACSW96270 (CA)

Record details

NPI number1083508857
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 5, 2025
Last updated in NPPESJune 5, 2025
Certification dateJune 5, 2025
Mailing address617 S Hudson Ave, Pasadena, CA 91106-3909

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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