Lydia Rosa Malcolm, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY10094 Issued in FL

Practice address

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

Phone

(954) 715-5477

Fax

(954) 998-7177

NPI assigned

Mar 2, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1598267809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18459 PINES BLVD # 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",
            "fax_number": "954-998-7177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOLM",
        "first_name": "LYDIA",
        "middle_name": "ROSA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-02",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya E Magrina
• Laura Mahoney
• Majestic Sunshine Care
• Vanessa Major
• Peter H Makar
• Tara-Marie Malcolm
• Ivette Maldonado Diaz, LMHC
• Francisco Javier Maldonado-Diaz
• Israel Maldonado Jr., D.C.
• Maria Fernanda Maldonado

• Clinical Psychologist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Clinical 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.