Provider Demographics
NPI:1710594759
Name:ROODE, AMY L (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:ROODE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:AHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:75 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-2609
Mailing Address - Country:US
Mailing Address - Phone:860-928-5900
Mailing Address - Fax:860-963-0100
Practice Address - Street 1:75 CHURCH ST
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277-2609
Practice Address - Country:US
Practice Address - Phone:860-928-5900
Practice Address - Fax:860-963-0100
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266726163W00000X, 363LP0808X
CT104956163W00000X
CT10283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse