Provider Demographics
NPI:1972087799
Name:MALOWITZ, SARA EMILY (PSYD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:EMILY
Last Name:MALOWITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 115TH AVE N APT 2104
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2653
Mailing Address - Country:US
Mailing Address - Phone:727-434-3262
Mailing Address - Fax:
Practice Address - Street 1:4404 S FLORIDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2183
Practice Address - Country:US
Practice Address - Phone:863-709-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical