Provider Demographics
NPI:1265709216
Name:KARTHA, MALLY KARUNAKARAN
Entity type:Individual
Prefix:MRS
First Name:MALLY
Middle Name:KARUNAKARAN
Last Name:KARTHA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SETHULAKSHMI
Other - Middle Name:KARUNAKARAN
Other - Last Name:KARTHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA
Mailing Address - Street 1:8630 TIDAL BAY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6284
Mailing Address - Country:US
Mailing Address - Phone:813-813-1801
Mailing Address - Fax:888-345-7010
Practice Address - Street 1:2311 ALT 19
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2631
Practice Address - Country:US
Practice Address - Phone:727-254-9183
Practice Address - Fax:888-345-7010
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3420A101YA0400X
FLSW 98751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)