Provider Demographics
NPI:1497936041
Name:VORWERK, MICHELLE LYNETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNETTE
Last Name:VORWERK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNETTE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3943 IRVINE BLVD
Mailing Address - Street 2:#321
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:949-892-9800
Mailing Address - Fax:714-389-6692
Practice Address - Street 1:3943 IRVINE BLVD
Practice Address - Street 2:#321
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2400
Practice Address - Country:US
Practice Address - Phone:949-892-9800
Practice Address - Fax:714-389-6692
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist