Individual
DR. BRENDA ANN VIDAL
Active
Individual
DR. BRENDA ANN VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
04302
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
412389100
—
MD
01
—
60484701
BCBS MD
MD
01
—
G3960046
BCBS DC
DC
01
—
P00384922
RR MEDICARE S
DE
Enumeration date
09/30/2006
Last updated
04/28/2008
Update your record
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