Provider Demographics
NPI:1184139123
Name:ROBINSON, MALITA (MSW)
Entity type:Individual
Prefix:
First Name:MALITA
Middle Name:
Last Name:ROBINSON
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 1:113 SE WHITMORE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3738
Mailing Address - Country:US
Mailing Address - Phone:570-972-6565
Mailing Address - Fax:
Practice Address - Street 1:113 SE WHITMORE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3738
Practice Address - Country:US
Practice Address - Phone:570-972-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health