MEDICARE: MISS KRISTINA THERESA MAGLIC MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	74120	CA
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	95144	CA

General Provider Information

NPI Number	:	1548639750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTINA THERESA MAGLIC MSW, LCSW

Provider Business Mailing Address
First Line	:	6303 OWENSMOUTH AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2264
Country	:	US
Telephone Number	:	818-384-0558
Fax Number	:	213-241-3305

Provider Business Practice Location Address
First Line	:	6303 OWENSMOUTH AVE STE 1083B
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2264
Country	:	US
Telephone Number	:	818-384-0558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/20/2023

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