Provider Demographics
NPI:1467517904
Name:BORRIE, RODERICK ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:ALLEN
Last Name:BORRIE
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 1:7 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2253
Mailing Address - Country:US
Mailing Address - Phone:631-689-1223
Mailing Address - Fax:631-689-1223
Practice Address - Street 1:7 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2253
Practice Address - Country:US
Practice Address - Phone:631-689-1223
Practice Address - Fax:631-689-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897754Medicaid
NY01897754Medicaid
NYVL9221Medicare ID - Type UnspecifiedMEDICARE #