Provider Demographics
NPI:1891975421
Name:HYDOCK, ROSALIE RITA (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:RITA
Last Name:HYDOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6929 N HAYDEN RD
Mailing Address - Street 2:C-4 #460
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7978
Mailing Address - Country:US
Mailing Address - Phone:480-282-2796
Mailing Address - Fax:480-775-8866
Practice Address - Street 1:8149 N HAYDEN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-292-7435
Practice Address - Fax:480-315-6528
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3869103TC0700X
TX33319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical