Provider Demographics
NPI:1689961658
Name:MICHAELS, MEREDITH LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LEIGH
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S BURNSIDE AVE APT 1L
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3953
Mailing Address - Country:US
Mailing Address - Phone:310-748-1708
Mailing Address - Fax:
Practice Address - Street 1:520 S BURNSIDE AVE APT 1L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3953
Practice Address - Country:US
Practice Address - Phone:310-748-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist