Provider Demographics
NPI:1578037842
Name:MAHABIR, ALTONIECE LEWIS (MSW)
Entity Type:Individual
Prefix:
First Name:ALTONIECE
Middle Name:LEWIS
Last Name:MAHABIR
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 1:3831 FUNSTON CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8583
Mailing Address - Country:US
Mailing Address - Phone:321-978-5315
Mailing Address - Fax:321-978-5316
Practice Address - Street 1:3831 FUNSTON CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8583
Practice Address - Country:US
Practice Address - Phone:321-978-5315
Practice Address - Fax:321-978-5316
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW-78151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty