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Individual

DR. MARIE CLAIRE RODERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
12591 WHIPPOORWILL ST, BROOMFIELD, CO 80020-7919
(571) 276-8939
Mailing address
280 E 1ST AVE, BROOMFIELD, CO 80020-2438
(571) 234-8106

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810005301
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005553
COLORADO LICENSE NUMBER
CO
01
0810005301
VA STATE LICENSURE NUMBER
VA
Enumeration date
02/11/2016
Last updated
10/05/2022
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