Provider Demographics
NPI:1386955847
Name:RODINO, ELAINE A (PHD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:A
Last Name:RODINO
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 1:141 E FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5315
Mailing Address - Country:US
Mailing Address - Phone:814-234-3464
Mailing Address - Fax:
Practice Address - Street 1:141 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5315
Practice Address - Country:US
Practice Address - Phone:814-234-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016694103T00000X
CAPSY6494103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist