Provider Demographics
NPI:1346457629
Name:MAHLATINI, SITHEMBILE (EDD, LCSW)
Entity Type:Individual
Prefix:
First Name:SITHEMBILE
Middle Name:
Last Name:MAHLATINI
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAPPHIRE PT UNIT 120
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5434
Mailing Address - Country:US
Mailing Address - Phone:781-254-1602
Mailing Address - Fax:888-306-7208
Practice Address - Street 1:1331 S INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:781-254-1602
Practice Address - Fax:888-306-7208
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71561041C0700X
MA1146161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767652200Medicaid