Healthcare Provider Details

I. General information

NPI: 1992316756
Provider Name (Legal Business Name): MICHELLE SCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W SUNSET BLVD STE P
LOS ANGELES CA
90026-3125
US

IV. Provider business mailing address

3435 OCEAN PARK BLVD # 107-54
SANTA MONICA CA
90405-3301
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-2066
  • Fax:
Mailing address:
  • Phone: 310-749-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: