Healthcare Provider Details

I. General information

NPI: 1396497707
Provider Name (Legal Business Name): BRENT WEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CEDAR FARMS DR
NEWARK DE
19702-3615
US

IV. Provider business mailing address

24 CEDAR FARMS DR
NEWARK DE
19702-3615
US

V. Phone/Fax

Practice location:
  • Phone: 302-593-2551
  • Fax:
Mailing address:
  • Phone: 302-593-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: