Provider Demographics
NPI:1750308789
Name:MALOWITZ, FERN (LMHC)
Entity Type:Individual
Prefix:
First Name:FERN
Middle Name:
Last Name:MALOWITZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4317
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-733-9598
Practice Address - Street 1:4160 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4317
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-733-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health