Provider Demographics
NPI:1285921023
Name:MENTAL HEALTH RESOURCES PC
Entity type:Organization
Organization Name:MENTAL HEALTH RESOURCES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-254-7388
Mailing Address - Street 1:PO BOX 2038
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-8638
Mailing Address - Country:US
Mailing Address - Phone:845-638-9079
Mailing Address - Fax:
Practice Address - Street 1:2311 ALT 19
Practice Address - Street 2:SUITE # 1
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2631
Practice Address - Country:US
Practice Address - Phone:727-254-7388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty