Breithaupt, Mark Douglas

Breithaupt, Mark Douglas is an individual health care provider with primary practice located at 1100 Lincoln Ave Ste 394 , San Jose CA 95125. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Marriage & Family Therapist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Breithaupt, Mark Douglas can be contacted via phone (408) 320-2747.

Contact Information

Primary practice address
1100 Lincoln Ave Ste 394 San Jose CA 95125
Phone: (408) 320-2747
Fax: (408) 320-2747
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X PSY 499 Hawaii
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X PSY 499 Hawaii
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY 499 Hawaii

Profile Details

NPI number 1053436337
LBN Legal business name Breithaupt, Mark Douglas
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 19th, 2007
Last updated Sep 9th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053436337 NPPES
Hawaii Other A 3812-3 HMSA
Hawaii MEDICAID 03451701 HMSA

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