Active NPI
Brenda Pedraza, PSY.D
- Clinical Psychologist
- Fort Bragg, NC
National Provider Identifier
1356530711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2774
- Practice address
- 117 La Bonneville Rd
Fort Bragg, NC 28307-3412 - Phone
- (910) 960-0600
- NPI assigned
- Oct 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2774 | PR | Primary |
Addresses
Primary practice location
117 La Bonneville Rd
Fort Bragg, NC 28307-3412
Mailing address
117 La Bonneville Rd
Fort Bragg, NC 28307-3412
Phone (910) 960-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2774 | PR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193011200000",
"number": "1356530711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 LA BONNEVILLE RD",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283073412",
"telephone_number": "910-960-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 LA BONNEVILLE RD",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283073412",
"telephone_number": "910-960-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDRAZA",
"first_name": "BRENDA",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-22",
"last_updated": "2007-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "2774",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.