Authentic Behavioral Health, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY10094 Issued in FL

Legal business name

AUTHENTIC BEHAVIORAL HEALTH, LLC

Practice address

9050 Pines Blvd Ste 450-00
Pembroke Pines, FL 33024-6455

Phone

(954) 715-5477

NPI assigned

Mar 13, 2018

Last updated

Jan 12, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lydia Rosa Malcolm, PHDNPI 1598267809

Title

Owner

Phone

(954) 715-5477

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lydia Rosa Malcolm, PHD

  • Clinical Psychologist
  • Pembroke Pines, FL
  • NPI 1598267809
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1487157715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18459 PINES BLVD STE 120",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330291400",
            "telephone_number": "954-715-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9050 PINES BLVD STE 450-00",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246455",
            "telephone_number": "954-715-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "ROSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-715-5477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY10094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Angela Avella de Perez, LCSW
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• Averhoff and Rodriguez MD PA
• Sara Alejandra Avila Rodriguez
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• Psychologist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.