Provider Demographics
NPI:1790810588
Name:MARCIAL, CHRISTIE LYNNE (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNNE
Last Name:MARCIAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:LYNNE
Other - Last Name:PANGANIBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3301 SUMMER ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0414
Mailing Address - Country:US
Mailing Address - Phone:909-930-1757
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD # A
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9300
Practice Address - Fax:909-421-9411
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW19889101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical