Provider Demographics
NPI:1396497707
Name:WEDMAN, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:WEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CEDAR FARMS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3615
Mailing Address - Country:US
Mailing Address - Phone:302-593-2551
Mailing Address - Fax:
Practice Address - Street 1:24 CEDAR FARMS DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3615
Practice Address - Country:US
Practice Address - Phone:302-593-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty