Healthcare Provider Details

I. General information

NPI: 1649968496
Provider Name (Legal Business Name): CECILIA MAGISTRALE-STATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 BANNOCK ST # 80204
DENVER CO
80204-5126
US

IV. Provider business mailing address

456 BANNOCK ST # 80204
DENVER CO
80204-5126
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1700
  • Fax:
Mailing address:
  • Phone: 303-504-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: