Provider Demographics
NPI:1104113448
Name:MALKOFF, HEATHER REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:REBECCA
Last Name:MALKOFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20155 NE 38TH CT
Mailing Address - Street 2:#702
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3126
Mailing Address - Country:US
Mailing Address - Phone:305-332-8500
Mailing Address - Fax:
Practice Address - Street 1:20155 NE 38TH CT
Practice Address - Street 2:#702
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3126
Practice Address - Country:US
Practice Address - Phone:305-332-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-8313103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist