Provider Demographics
NPI:1629596101
Name:BARTLETT, MICHELE (LCSW, CT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16814 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1736
Mailing Address - Country:US
Mailing Address - Phone:818-617-1123
Mailing Address - Fax:
Practice Address - Street 1:16814 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-1736
Practice Address - Country:US
Practice Address - Phone:818-617-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALC725551041C0700X
CA72555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty