Provider Demographics
NPI:1447457601
Name:O'LEARY, MICHELE ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ROSE
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1617 LYMAN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5435
Mailing Address - Country:US
Mailing Address - Phone:323-633-7990
Mailing Address - Fax:
Practice Address - Street 1:12200 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2804
Practice Address - Country:US
Practice Address - Phone:562-622-4150
Practice Address - Fax:562-622-4166
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW214451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical