Healthcare Provider Details

I. General information

NPI: 1659573079
Provider Name (Legal Business Name): CRISTINA LILIAN MAGALHAES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E WALNUT ST SUITE 201
PASADENA CA
91101-1676
US

IV. Provider business mailing address

84 N WILSON AVE APT 302
PASADENA CA
91106-2345
US

V. Phone/Fax

Practice location:
  • Phone: 954-937-0240
  • Fax:
Mailing address:
  • Phone: 954-937-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7638
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: