MEDICARE: MR. DAYLE ANTHONY PROVENCHER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09932904	CO

General Provider Information

NPI Number	:	1215882246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAYLE ANTHONY PROVENCHER LCSW

Provider Business Mailing Address
First Line	:	4825 ESTES ST
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80002-4229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 DOVER ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-3106
Country	:	US
Telephone Number	:	720-323-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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