Provider Demographics
NPI:1568704807
Name:COLARUSSO, MICHELLE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:COLARUSSO
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 1:1582 W. SAN MARCOS BLVD.
Mailing Address - Street 2:STE. 105
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4081
Mailing Address - Country:US
Mailing Address - Phone:760-522-7158
Mailing Address - Fax:760-539-7357
Practice Address - Street 1:1582 W. SAN MARCOS BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-522-7158
Practice Address - Fax:760-539-7357
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0770201041C0700X
CA271301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical