Provider Demographics
NPI:1750123386
Name:URBACH, MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:URBACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 VENTURA BLVD STE 1019
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2822
Mailing Address - Country:US
Mailing Address - Phone:818-939-5141
Mailing Address - Fax:
Practice Address - Street 1:15910 VENTURA BLVD STE 1019
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2822
Practice Address - Country:US
Practice Address - Phone:818-939-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240064471041C0700X
VA09040162391041C0700X
AZ221311041C0700X
CA206921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical