Provider Demographics
NPI:1275895732
Name:CALIXTRO, SIOMARA MAGALY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SIOMARA
Middle Name:MAGALY
Last Name:CALIXTRO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 WOODMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-899-8499
Mailing Address - Fax:844-590-1562
Practice Address - Street 1:6305 WOODMAN AVE.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401
Practice Address - Country:US
Practice Address - Phone:818-908-4999
Practice Address - Fax:844-590-1562
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115058106H00000X
CA119204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275895732Medicaid
CA6758Medicaid
CA7068Medicaid