Provider Demographics
NPI:1063906451
Name:RINALDI, ANTHONY P (PHD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:RINALDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1491
Mailing Address - Country:US
Mailing Address - Phone:518-510-3100
Mailing Address - Fax:608-410-2905
Practice Address - Street 1:15 CORNELL RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1491
Practice Address - Country:US
Practice Address - Phone:518-510-3100
Practice Address - Fax:608-410-2905
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3588-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063906451Medicaid