Provider Demographics
NPI:1558601708
Name:BORETZ, MICHAEL JULIAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JULIAN
Last Name:BORETZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 FIRESTONE BLVD STE 3001
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4300
Mailing Address - Country:US
Mailing Address - Phone:668-698-6608
Mailing Address - Fax:
Practice Address - Street 1:475 750 RICE CANYON ROAD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96127
Practice Address - Country:US
Practice Address - Phone:530-251-5100
Practice Address - Fax:530-251-5017
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS206101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical