Provider Demographics
NPI:1790188670
Name:MAGPAYO, MARY CAROLINE
Entity Type:Individual
Prefix:MRS
First Name:MARY CAROLINE
Middle Name:
Last Name:MAGPAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY CAROLINE
Other - Middle Name:
Other - Last Name:MOTUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:22445 ALESSANDRO BLVD STE 113-114
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8358
Mailing Address - Country:US
Mailing Address - Phone:951-924-9791
Mailing Address - Fax:
Practice Address - Street 1:22445 ALESSANDRO BLVD STE 113-114
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8358
Practice Address - Country:US
Practice Address - Phone:951-924-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA937931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker