Provider Demographics
NPI:1225264351
Name:RINALDI, TRACEY LYN (PYSCHOLOGY ASSOCIATE)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYN
Last Name:RINALDI
Suffix:
Gender:F
Credentials:PYSCHOLOGY ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7100 NAVARETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3750
Mailing Address - Country:US
Mailing Address - Phone:805-286-8317
Mailing Address - Fax:805-464-0374
Practice Address - Street 1:7100 NAVARETTE AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3750
Practice Address - Country:US
Practice Address - Phone:805-286-8317
Practice Address - Fax:805-464-0374
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA278222251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225264351Medicaid