Provider Demographics
NPI:1861559361
Name:GORCEY, MICHELE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:GORCEY
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 1:215 S NARDO AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2022
Mailing Address - Country:US
Mailing Address - Phone:858-793-2467
Mailing Address - Fax:858-523-1037
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3082
Practice Address - Country:US
Practice Address - Phone:858-793-2467
Practice Address - Fax:858-523-1037
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS130491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015530OtherVALUEOPTIONS
CASW13049Medicare ID - Type UnspecifiedNHIC CORP