Provider Demographics
NPI:1356782585
Name:CARCEL, MICHELLE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:CARCEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 FAY AVE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4885
Mailing Address - Country:US
Mailing Address - Phone:858-337-5258
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4885
Practice Address - Country:US
Practice Address - Phone:858-337-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical