Provider Demographics
NPI:1639443443
Name:MAGNELIA, CHRISTOPHER (MA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:MAGNELIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12668 KENWOOD LN
Mailing Address - Street 2:UNIT C
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5655
Mailing Address - Country:US
Mailing Address - Phone:239-699-1158
Mailing Address - Fax:
Practice Address - Street 1:12668 KENWOOD LN
Practice Address - Street 2:UNIT C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5655
Practice Address - Country:US
Practice Address - Phone:239-699-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health