Provider Demographics
NPI:1396463816
Name:PUNLA, MICHELLE LYNN (ASW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:PUNLA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:MERLONGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6372
Mailing Address - Country:US
Mailing Address - Phone:707-784-8576
Mailing Address - Fax:
Practice Address - Street 1:675 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6372
Practice Address - Country:US
Practice Address - Phone:707-784-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical