Provider Demographics
NPI:1871135665
Name:GALORDI, TINA M (PSYD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:GALORDI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2857
Mailing Address - Country:US
Mailing Address - Phone:415-269-3657
Mailing Address - Fax:
Practice Address - Street 1:1414 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2857
Practice Address - Country:US
Practice Address - Phone:415-269-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical