Provider Demographics
NPI:1295061737
Name:LEE, MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:RUDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX HH
Mailing Address - Street 2:CHOMP/GP
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942
Mailing Address - Country:US
Mailing Address - Phone:831-625-4775
Mailing Address - Fax:831-625-4778
Practice Address - Street 1:23625 PACIFIC GROVE-CARMEL HWY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93942
Practice Address - Country:US
Practice Address - Phone:831-625-4775
Practice Address - Fax:831-625-4778
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29411104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker