Provider Demographics
NPI:1881433688
Name:RODENBUSH, SOPHIE (PHD)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:RODENBUSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LEAR JET LN STE 104N
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2314
Mailing Address - Country:US
Mailing Address - Phone:518-560-4277
Mailing Address - Fax:518-662-4277
Practice Address - Street 1:3 LEAR JET LN STE 104N
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2314
Practice Address - Country:US
Practice Address - Phone:518-560-4277
Practice Address - Fax:518-662-4277
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist