Provider Demographics
NPI:1023036266
Name:KELSEY-PLUMMER, MICHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:KELSEY-PLUMMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KELSEY
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:15 EAGLEPOINT
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656
Mailing Address - Country:US
Mailing Address - Phone:562-826-5918
Mailing Address - Fax:562-826-5244
Practice Address - Street 1:5901 EAST 7TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-5918
Practice Address - Fax:562-826-5244
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072282104100000X
DEQ1-00119721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker