Organization
MARIE CLAIRE RODERICK PSYD LLC
Active
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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