Provider Demographics
NPI:1003056680
Name:ATEIA, MAGGIE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:J
Last Name:ATEIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 SWIFTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4606
Mailing Address - Country:US
Mailing Address - Phone:626-441-0234
Mailing Address - Fax:
Practice Address - Street 1:415 W ROUTE 66
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-524-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical