Provider Demographics
NPI:1851585392
Name:CRASKE, MICHELLE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:G
Last Name:CRASKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N LINDEN DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2247
Mailing Address - Country:US
Mailing Address - Phone:310-825-8403
Mailing Address - Fax:
Practice Address - Street 1:462 N LINDEN DR
Practice Address - Street 2:SUITE 430
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2247
Practice Address - Country:US
Practice Address - Phone:310-825-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12898103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12898AMedicare PIN