Provider Demographics
NPI:1841546579
Name:MAHALKO, JARRETTA DEE (LCSW)
Entity type:Individual
Prefix:
First Name:JARRETTA
Middle Name:DEE
Last Name:MAHALKO
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 1:3322 ST VINCENT TER
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4098
Mailing Address - Country:US
Mailing Address - Phone:801-513-8922
Mailing Address - Fax:
Practice Address - Street 1:3322 ST VINCENT TER
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4098
Practice Address - Country:US
Practice Address - Phone:801-513-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0068361041C0700X
UT9418992-35011041C0700X
FLSW221601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical