Provider Demographics
NPI:1659573079
Name:MAGALHAES, CRISTINA LILIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:LILIAN
Last Name:MAGALHAES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 N WILSON AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2345
Mailing Address - Country:US
Mailing Address - Phone:954-937-0240
Mailing Address - Fax:
Practice Address - Street 1:711 E WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1676
Practice Address - Country:US
Practice Address - Phone:954-937-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7638101YM0800X
CAPSY23830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767898300Medicaid