Provider Demographics
NPI:1891029336
Name:MALHOTRA, RUCHI (LCSW)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:MALHOTRA
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 1:1852 STARGAZER TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9287
Mailing Address - Country:US
Mailing Address - Phone:352-729-1995
Mailing Address - Fax:
Practice Address - Street 1:1852 STARGAZER TER
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9287
Practice Address - Country:US
Practice Address - Phone:352-729-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 130921041C0700X
FL130921041C0700X
IN34006212A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100073590Medicaid
FL1891029336Medicaid