Healthcare Provider Details

I. General information

NPI: 1538573936
Provider Name (Legal Business Name): KEITH ERIC BREDEMEIER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DISCOVERY BLVD FL 6
NEWARK DE
19713-1325
US

IV. Provider business mailing address

100 DISCOVERY BLVD FL 6
NEWARK DE
19713-1325
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2717
  • Fax: 302-831-0405
Mailing address:
  • Phone: 302-831-2717
  • Fax: 302-831-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018559
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0001059
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: