Provider Demographics
NPI:1376165274
Name:RODENBURG, FRANCES ANN (PHD, LADC)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:ANN
Last Name:RODENBURG
Suffix:
Gender:F
Credentials:PHD, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1519
Mailing Address - Country:US
Mailing Address - Phone:207-239-2356
Mailing Address - Fax:
Practice Address - Street 1:14 KELLEY WAY
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2762
Practice Address - Country:US
Practice Address - Phone:707-225-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6785101YA0400X
MEPS1608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)