Provider Demographics
NPI:1841232220
Name:BREDE, TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:BREDE
Suffix:
Gender:M
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:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-0882
Mailing Address - Country:US
Mailing Address - Phone:603-382-5400
Mailing Address - Fax:603-382-4283
Practice Address - Street 1:144 PINECREST RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:NH
Practice Address - Zip Code:03052-2325
Practice Address - Country:US
Practice Address - Phone:603-382-5400
Practice Address - Fax:603-382-4283
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH858174400000X
MAMA7293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRW50335Medicare ID - Type Unspecified
NHW5033502Medicare PIN