Provider Demographics
NPI:1386765873
Name:ROSS, MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 S BEVERLY GLEN BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6910
Mailing Address - Country:US
Mailing Address - Phone:310-474-5513
Mailing Address - Fax:310-474-2136
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:#421
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:213-427-8658
Practice Address - Fax:310-474-2136
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 197891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical