Healthcare Provider Details

I. General information

NPI: 1407030216
Provider Name (Legal Business Name): SARA ROSA MALAGOLD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HOLLYWOOD BLVD SUITE 201
HOLLYWOOD FL
33024-7900
US

IV. Provider business mailing address

3215 NE 184TH ST APT. 14203
AVENTURA FL
33160-4994
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-8052
  • Fax: 954-966-4774
Mailing address:
  • Phone: 305-725-2575
  • Fax: 954-748-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: