Provider Demographics
NPI:1205856200
Name:ROEDEMA, THOMAS M (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:ROEDEMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 S BUTLER ROAD
Mailing Address - Street 2:
Mailing Address - City:MT GRETNA
Mailing Address - State:PA
Mailing Address - Zip Code:17064
Mailing Address - Country:US
Mailing Address - Phone:800-932-0359
Mailing Address - Fax:
Practice Address - Street 1:283 S BUTLER ROAD
Practice Address - Street 2:
Practice Address - City:MT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064
Practice Address - Country:US
Practice Address - Phone:800-932-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPS029949103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist