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General NPI Number Information
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NPI Number | 1598267809
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Entity Type | Individual
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Provider Name | LYDIA ROSA MALCOLM PHD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 450-00
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6455
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Country | US
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Telephone | 954-715-5477
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Fax | 954-998-7177
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Provider Business Mailing Address
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Address Line | 18459 PINES BLVD # 120
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1400
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Country | US
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Telephone | 954-715-5477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10094
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License Number State | FL
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