Organization
SRM CLINICAL PSYCHOLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA MALAGOLD (PRESIDENT)
(954) 962-8052
Entity
Organization
Contact information
Practice address
6100 HOLLYWOOD BLVD, SUITE 201, HOLLYWOOD, FL 33024-7900
(954) 962-8052
(954) 966-4774
Mailing address
3215 NE 184TH ST, APTO 14203, NORTH MIAMI BEACH, FL 33160-4994
(954) 962-8052
(954) 966-4774
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
7360
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7360
LIC
FL
Enumeration date
01/05/2009
Last updated
08/20/2009
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