Provider Demographics
NPI:1568249829
Name:FRAN RODENBURG, PH.D., LADC,LLC
Entity Type:Organization
Organization Name:FRAN RODENBURG, PH.D., LADC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RODENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LADC,LLC
Authorized Official - Phone:207-239-2356
Mailing Address - Street 1:14 KELLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2762
Mailing Address - Country:US
Mailing Address - Phone:207-239-2356
Mailing Address - Fax:
Practice Address - Street 1:585 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1519
Practice Address - Country:US
Practice Address - Phone:207-239-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health