Provider Demographics
NPI:1942300546
Name:MALMAUD, ROSLYN KAREN (PHD)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:KAREN
Last Name:MALMAUD
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 1:3975 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-271-6776
Mailing Address - Fax:561-368-0459
Practice Address - Street 1:500 NE SPANISH RIVER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4500
Practice Address - Country:US
Practice Address - Phone:561-271-6776
Practice Address - Fax:561-997-9971
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4234103TC0700X
CA20069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32003OtherNATIONAL REGISTER 4 PSYCH
FL11403681OtherAETNA
FL11403681OtherCAQH #
FL240591220OtherUNITED BEHAVIORAL HEALTH
FL180217OtherVALUE OPTIONS
FL81962OtherFIRST HEALTH
FL32003OtherNATIONAL REGISTER 4 PSYCH
CAPSY 20069Medicare UPIN
FLPY 4234Medicare UPIN
FL81962OtherFIRST HEALTH