Provider Demographics
NPI:1841361631
Name:MULLIN, SARITA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARITA
Middle Name:MARIE
Last Name:MULLIN
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 1:25 PONTE VEDRA CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1315
Mailing Address - Country:US
Mailing Address - Phone:904-868-9114
Mailing Address - Fax:
Practice Address - Street 1:25 PONTE VEDRA CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1315
Practice Address - Country:US
Practice Address - Phone:904-868-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker