Healthcare Provider Details

I. General information

NPI: 1144616731
Provider Name (Legal Business Name): MAGALIE ROMAN-ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGALIE ESTRADA-MORA MSW

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S 2ND AVE
YAKIMA WA
98902-3414
US

IV. Provider business mailing address

33 S 2ND AVE
YAKIMA WA
98902-3414
US

V. Phone/Fax

Practice location:
  • Phone: 509-864-7944
  • Fax:
Mailing address:
  • Phone: 509-864-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61403044
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: