MEDICARE: FRAN RODENBURG, PH.D., LADC,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1568249829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAN RODENBURG, PH.D., LADC,LLC

Provider Business Mailing Address
First Line	:	14 KELLEY WAY
Second Line	:
City	:	WESTBROOK
State	:	ME
Zip	:	04092-2762
Country	:	US
Telephone Number	:	207-239-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 FOREST AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-1519
Country	:	US
Telephone Number	:	207-239-2356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRAN ANN RODENBURG
Credential	:	PH.D, LADC,LLC
Telephone Number	:	207-239-2356

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	03/15/2024

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