Provider Demographics
NPI:1104544337
Name:MICHEL-JAIME, GLORIA (ASW)
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:
Last Name:MICHEL-JAIME
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:672 BRADSHAWE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3403
Mailing Address - Country:US
Mailing Address - Phone:323-395-9379
Mailing Address - Fax:
Practice Address - Street 1:4675 VIA LOS SANTOS
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1346
Practice Address - Country:US
Practice Address - Phone:323-395-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1098671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical