Basic Information
| Provider Information | |||||||||
| NPI: | 1780214478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 301 CHERRY LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096476247 | ||||||||
| FaxNumber: | 2096476210 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 CHERRY LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096476247 | ||||||||
| FaxNumber: | 2096476210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2020 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW92259 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.