Individual
DR. MARIE CLAIRE RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
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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