Provider Demographics
NPI:1538632500
Name:MALANDRINO, RIGBY D
Entity type:Individual
Prefix:
First Name:RIGBY
Middle Name:D
Last Name:MALANDRINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 ROLLING HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6865
Mailing Address - Country:US
Mailing Address - Phone:704-662-5459
Mailing Address - Fax:
Practice Address - Street 1:344 ROLLING HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6865
Practice Address - Country:US
Practice Address - Phone:704-662-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1213241103TS0200X
NC5467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool