Provider Demographics
NPI:1104954536
Name:BREDA, MALINDA L (PHD)
Entity type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:L
Last Name:BREDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:
Other - Last Name:HOLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2000 NEUSE BLVD
Mailing Address - Street 2:PO BOX 12157
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-3449
Mailing Address - Country:US
Mailing Address - Phone:252-633-8020
Mailing Address - Fax:252-633-8954
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28561
Practice Address - Country:US
Practice Address - Phone:252-633-8020
Practice Address - Fax:252-633-8954
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21212103TC0700X
NC4050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical