Provider Demographics
NPI:1427364462
Name:POWERS-MAGRO, CALLAN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:CALLAN
Middle Name:ELIZABETH
Last Name:POWERS-MAGRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CALLAN
Other - Middle Name:ELIZABETH
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1963 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2394
Mailing Address - Country:US
Mailing Address - Phone:619-233-3432
Mailing Address - Fax:
Practice Address - Street 1:6462 LANCE WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2927
Practice Address - Country:US
Practice Address - Phone:310-408-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY32014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health