Provider Demographics
NPI:1407464464
Name:DUKES, MALESA (MSW, RCSWI)
Entity Type:Individual
Prefix:MRS
First Name:MALESA
Middle Name:
Last Name:DUKES
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631B COLONIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4205
Mailing Address - Country:US
Mailing Address - Phone:352-256-0134
Mailing Address - Fax:
Practice Address - Street 1:631B COLONIAL ST SE
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4205
Practice Address - Country:US
Practice Address - Phone:352-256-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW147251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical