Provider Demographics
NPI:1134292113
Name:PERLMUTTER, MICHELLE D (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1601
Mailing Address - Country:US
Mailing Address - Phone:818-889-8048
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7302
Practice Address - Country:US
Practice Address - Phone:818-889-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical