Provider Demographics
NPI:1356530711
Name:PEDRAZA, BRENDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:PEDRAZA
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 1:117 LA BONNEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-3412
Mailing Address - Country:US
Mailing Address - Phone:910-960-0600
Mailing Address - Fax:
Practice Address - Street 1:117 LA BONNEVILLE RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307-3412
Practice Address - Country:US
Practice Address - Phone:910-960-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical