| Marie Claire Roderick Psyd Llc | |
|
12591 Whippoorwill St Broomfield CO 80020-7919 | |
| (571) 276-8939 | |
| Not Available |
| Full Name | Marie Claire Roderick Psyd Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 12591 Whippoorwill St, Broomfield, Colorado |
| Authorized Official Name and Position | Marie Claire Roderick (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5712348106 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marie Claire Roderick Psyd Llc Po Box 756 Broomfield CO 80038-0756 Ph: (571) 234-8106 | Marie Claire Roderick Psyd Llc 12591 Whippoorwill St Broomfield CO 80020-7919 Ph: (571) 276-8939 |
| NPI Number | 1174246466 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 10/17/2022 |
| Certification Date | 10/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174246466 | NPI | - | NPPES |
| 1851750376 | Other | MD | NPI INDIVIDUAL NUMBER |
| 0810005301 | Other | VA | VA STATE LICENSE TO PRACTICE AS A CLINICAL PSYCHOLOGIST |
| 0005553 | Other | CO | STATE OF COLORADO STATE LICENSE TO PRACTICE CLINICAL PSYCHOLOGY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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