Provider Demographics
NPI:1962525287
Name:RODERICK, HELENA A (PHD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:A
Last Name:RODERICK
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 1:543 MAIN ST
Mailing Address - Street 2:UNIT 308
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7214
Mailing Address - Country:US
Mailing Address - Phone:914-819-8803
Mailing Address - Fax:718-235-1291
Practice Address - Street 1:999 JAMAICA AVE
Practice Address - Street 2:NS-LIJ STUDENT HEALTH CENTER AT F.K. LANE HIGH SCHOOL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1503
Practice Address - Country:US
Practice Address - Phone:718-235-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015492-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent