Provider Demographics
NPI:1760464002
Name:ZITOWITZ, KATHLEEN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:ZITOWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 MARLIN ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-2320
Mailing Address - Country:US
Mailing Address - Phone:941-321-2214
Mailing Address - Fax:
Practice Address - Street 1:1466 MARLIN ST
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-2320
Practice Address - Country:US
Practice Address - Phone:941-321-2214
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9573ZMedicare ID - Type UnspecifiedLCSW