Provider Demographics
NPI:1093754434
Name:BREMER, DEBORAH (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BREMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 PEMBERTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4474
Mailing Address - Country:US
Mailing Address - Phone:804-741-7500
Mailing Address - Fax:804-741-7900
Practice Address - Street 1:1403 PEMBERTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4474
Practice Address - Country:US
Practice Address - Phone:804-741-7500
Practice Address - Fax:804-741-7900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137453OtherBLUE CROSS
VA003056C90Medicare ID - Type UnspecifiedMEDICARE