Provider Demographics
NPI:1083876635
Name:MAGALLANES, MARIA LUISA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:MAGALLANES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WILLOW ROAD
Mailing Address - Street 2:BUILDING 324, ROOM B140, MAIL CODE 180 MPD
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2669
Practice Address - Street 1:795 WILLOW ROAD
Practice Address - Street 2:BUILDING 324, MAIL CODE 180 MPD
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2669
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282821041C0700X
CAASW 169601041C0700X
CAASW 282441041C0700X, 101YM0800X
CALCS 28282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health