Provider Demographics
NPI:1255142832
Name:BROOKS, KRISTINA MALANDRO
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MALANDRO
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18617 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6020
Mailing Address - Country:US
Mailing Address - Phone:818-747-5526
Mailing Address - Fax:
Practice Address - Street 1:17702 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-1635
Practice Address - Country:US
Practice Address - Phone:888-770-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94027854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical