Provider Demographics
NPI:1962807727
Name:MADORY, CRISTINA (MSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MADORY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S GRAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4434
Mailing Address - Country:US
Mailing Address - Phone:714-567-7508
Mailing Address - Fax:714-567-7633
Practice Address - Street 1:1300 S GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-567-7508
Practice Address - Fax:714-567-7633
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA852041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator