MEDICARE: MICHELLE SUSAN BOYD VILLEGAS L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	20660	CA

General Provider Information

NPI Number	:	1639338973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SUSAN BOYD VILLEGAS L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 719
Second Line	:
City	:	CARPINTERIA
State	:	CA
Zip	:	93014-0719
Country	:	US
Telephone Number	:	805-570-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1482 E VALLEY RD STE 11
Second Line	:
City	:	MONTECITO
State	:	CA
Zip	:	93108-1200
Country	:	US
Telephone Number	:	805-570-1217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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