Provider Demographics
NPI:1386940484
Name:BRAY, MICHELE LYNN (MSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:BRAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:PALMER
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2713 RALSTON LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4616
Mailing Address - Country:US
Mailing Address - Phone:310-739-4055
Mailing Address - Fax:
Practice Address - Street 1:11835 W. OLYMPIC BLVD SUITE 1090
Practice Address - Street 2:SOCIAL SERVICE PROFESSIONALS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-473-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW#86031041C0700X
CAACSW 2ND # PENDING1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical