Provider Demographics
NPI:1386841534
Name:CLISBY, MICHELLE D (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:CLISBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 REDWING LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-6254
Mailing Address - Country:US
Mailing Address - Phone:805-485-7172
Mailing Address - Fax:805-988-2941
Practice Address - Street 1:2480 REDWING LN
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-6254
Practice Address - Country:US
Practice Address - Phone:805-485-7172
Practice Address - Fax:805-988-2941
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 17598104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker