1497936041 NPI number — DR. MICHELLE LYNETTE VORWERK PSY.D.

Table of content: LUKE ROMANO (NPI 1053995142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497936041 NPI number — DR. MICHELLE LYNETTE VORWERK PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VORWERK
Provider First Name:
MICHELLE
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNETTE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497936041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3943 IRVINE BLVD
Provider Second Line Business Mailing Address:
#321
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92602-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-892-9800
Provider Business Mailing Address Fax Number:
714-389-6692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3943 IRVINE BLVD
Provider Second Line Business Practice Location Address:
#321
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92602-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-892-9800
Provider Business Practice Location Address Fax Number:
714-389-6692
Provider Enumeration Date:
11/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY21119 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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