Provider Demographics
NPI:1407030216
Name:MALAGOLD, SARA ROSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ROSA
Last Name:MALAGOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 NE 184TH ST
Mailing Address - Street 2:APT. 14203
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4994
Mailing Address - Country:US
Mailing Address - Phone:305-725-2575
Mailing Address - Fax:954-748-7772
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7900
Practice Address - Country:US
Practice Address - Phone:954-962-8052
Practice Address - Fax:954-966-4774
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA916ZMedicare PIN