Provider Demographics
NPI:1689663668
Name:MICHAELSON, MARGE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARGE
Middle Name:R
Last Name:MICHAELSON
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 1:13451 BARBADOS WAY
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3503
Mailing Address - Country:US
Mailing Address - Phone:858-755-3343
Mailing Address - Fax:
Practice Address - Street 1:341 S CEDROS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1985
Practice Address - Country:US
Practice Address - Phone:858-792-8586
Practice Address - Fax:858-792-8587
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS47121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical