Active NPI
Tara-Marie Malcolm
- Behavior Technician
- Pembroke Pines, FL
National Provider Identifier
1518333780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-26-2841559
- Practice address
- 11940 SW 12TH St
Building 115
Pembroke Pines, FL 33025-5719 - Phone
- (954) 274-2057
- NPI assigned
- Aug 11, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-26-2841559 | FL | Primary |
| Behavior Technician | 106S00000X | BACB301120 | FL |
Addresses
Primary practice location
11940 SW 12TH St
Building 115
Pembroke Pines, FL 33025-5719
Mailing address
11940 SW 12TH Street
Building 115
Pembroke Pines, FL 33025
Phone (954) 274-2057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB301120 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789516800000",
"number": "1518333780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11940 SW 12TH STREET",
"address_2": "BUILDING 115",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "33025",
"telephone_number": "954-274-2057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11940 SW 12TH ST",
"address_2": "BUILDING 115",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330255719",
"telephone_number": "954-274-2057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOLM",
"first_name": "TARA-MARIE",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-11",
"last_updated": "2026-09-16",
"certification_date": "2026-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1-26-2841559",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "BACB301120",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.