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MARK D BREITHAUPT PHD INC NPI 1902115082


NPI Information

NPI: 1902115082
Provider Name: MARK D BREITHAUPT PHD INC
Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
1100 LINCOLN AVE STE 394
SAN JOSE, CA
ZIP 95125
Phone: (408) 320-2747
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MARK D BREITHAUPT PHD INC is a clinical psychologist in San Jose, CA. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. MARK D BREITHAUPT PHD INC NPI is 1902115082. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1100 LINCOLN AVE STE 394
SAN JOSE, CA
ZIP 95125
Phone: (408) 320-2747
Fax: (408) 320-2747

The provider's authorized official is Mark Douglas Breithaupt .
The authorized official title is Licensed Clinical Psychologist and has the following contact phone number (408) 320-2747.

The enumeration date for this NPI number is 10/6/2010 and was last updated on 9/9/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103T00000XPsychologistPSY499HAWAIINo
2103TA0400XPsychologistAddiction (Substance Use Disorder)PSY499HAWAIINo
3106H00000XMarriage & Family TherapistPSY499HAWAIINo
4103TC0700XPsychologistClinicalPSY499HAWAIIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
103451701MEDICAIDHAWAII
2HMSAOTHERHAWAIIHMSA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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