Provider Demographics
NPI:1376549808
Name:BIERDEMAN, BRENDA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:BIERDEMAN
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 1:27 S PLATT ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1431
Mailing Address - Country:US
Mailing Address - Phone:585-589-2315
Mailing Address - Fax:585-589-1036
Practice Address - Street 1:27 S PLATT ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1431
Practice Address - Country:US
Practice Address - Phone:585-589-2315
Practice Address - Fax:585-589-1036
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012329-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000523807001OtherBLUE CROSS BLUE SHIELD
6892936OtherEMPIRE/GHI/VALUE OPTIONS
7013327OtherAETNA
NYF010012329OtherBLUE CHOICE
040426031011OtherFIDELIS
103226FCOtherPREFERRED CARE
6107851OtherINDEPENDENT HEALTH
NY01572036Medicaid
S12329-9BOtherWOKER'S COMP
NY01572036Medicaid