Provider Demographics
NPI:1689809279
Name:AMESTOY, M MICHELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:M MICHELE
Middle Name:
Last Name:AMESTOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY MICHELE
Other - Middle Name:
Other - Last Name:AMESTOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PPS
Mailing Address - Street 1:600 S COMMONWEALTH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4001
Mailing Address - Country:US
Mailing Address - Phone:213-739-2357
Mailing Address - Fax:
Practice Address - Street 1:600 S COMMONWEALTH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4001
Practice Address - Country:US
Practice Address - Phone:213-739-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 219381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical