Provider Demographics
NPI:1891018263
Name:RUMALDO, ANGIE (PHD, PMH-NP)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:
Last Name:RUMALDO
Suffix:
Gender:F
Credentials:PHD, PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 236TH ST
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1748
Mailing Address - Country:US
Mailing Address - Phone:718-701-5833
Mailing Address - Fax:888-635-6499
Practice Address - Street 1:530 W 236TH ST
Practice Address - Street 2:SUITE 1K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1748
Practice Address - Country:US
Practice Address - Phone:718-701-5833
Practice Address - Fax:888-635-6499
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2016-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018514103T00000X, 103TC0700X, 103TC2200X
NYF402055-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03216259Medicaid