Provider Demographics
NPI:1215778287
Name:RITORTO, GINA NICHOLE (MA, PPS)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:NICHOLE
Last Name:RITORTO
Suffix:
Gender:F
Credentials:MA, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PRINGLE AVE UNIT A418
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3972
Mailing Address - Country:US
Mailing Address - Phone:661-203-4582
Mailing Address - Fax:
Practice Address - Street 1:39 QUAIL CT STE 103
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5568
Practice Address - Country:US
Practice Address - Phone:661-203-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist