Healthcare Provider Details

I. General information

NPI: 1063906451
Provider Name (Legal Business Name): ANTHONY P RINALDI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORNELL RD
LATHAM NY
12110-1491
US

IV. Provider business mailing address

76 WAVERLY CIR
WATERVLIET NY
12189-1625
US

V. Phone/Fax

Practice location:
  • Phone: 518-510-3100
  • Fax: 608-410-2905
Mailing address:
  • Phone: 630-779-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3588-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: