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General NPI Number Information
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NPI Number | 1578014692
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Entity Type | Individual
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Provider Name | VANESSA ANNE MAGRO
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 5738 OLDE WADSWORTH BLVD
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City | ARVADA
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State | CO
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Zip | 80002-2535
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Country | US
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Telephone | 510-317-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 2275 ARLINGTON DR
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1132
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Country | US
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Telephone | 510-317-1445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0006736
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License Number State | CO
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