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Organization

MARIE CLAIRE RODERICK PSYD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARIE CLAIRE RODERICK PSYD (CLINICAL PSYCHOLOGIST)
(571) 234-8106
Entity
Organization

Contact information

Practice address
12591 WHIPPOORWILL ST, BROOMFIELD, CO 80020-7919
(571) 276-8939
Mailing address
PO BOX 756, BROOMFIELD, CO 80038-0756
(571) 234-8106

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005553
STATE OF COLORADO STATE LICENSE TO PRACTICE CLINICAL PSYCHOLOGY
CO
01
0810005301
VA STATE LICENSE TO PRACTICE AS A CLINICAL PSYCHOLOGIST
VA
01
1851750376
NPI INDIVIDUAL NUMBER
MD
Enumeration date
09/21/2022
Last updated
10/17/2022
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