Provider Demographics
NPI:1548639750
Name:MAGLIC, KRISTINA THERESA (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:THERESA
Last Name:MAGLIC
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 OWENSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2264
Mailing Address - Country:US
Mailing Address - Phone:818-384-0558
Mailing Address - Fax:213-241-3305
Practice Address - Street 1:6303 OWENSMOUTH AVE STE 1083B
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2264
Practice Address - Country:US
Practice Address - Phone:818-384-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74120101YM0800X
1041C0700X
CA951441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health