Provider Demographics
NPI:1790567824
Name:SERRANO, MICHELLE STEPHANIE (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:STEPHANIE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N REINO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3714
Mailing Address - Country:US
Mailing Address - Phone:818-338-5703
Mailing Address - Fax:
Practice Address - Street 1:456 N REINO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3714
Practice Address - Country:US
Practice Address - Phone:818-338-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist