Provider Demographics
NPI:1376722389
Name:RODDY, JEAN-MARIE MARHEFKA (LCPC)
Entity Type:Individual
Prefix:
First Name:JEAN-MARIE
Middle Name:MARHEFKA
Last Name:RODDY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEAN-MARIE
Other - Middle Name:
Other - Last Name:LEAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:9041 NAYGALL RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1335
Mailing Address - Country:US
Mailing Address - Phone:434-473-2332
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2370
Practice Address - Country:US
Practice Address - Phone:410-656-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2183101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012579200Medicaid