Healthcare Provider Details

I. General information

NPI: 1144245515
Provider Name (Legal Business Name): SAGE DEBEIXEDON BRESLIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN YVETTE DEBEIXEDON PHD

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DRIVE SUITE 226B
CARDIFF-BY-THE-SEA CA
92007-2408
US

IV. Provider business mailing address

120 BIRMINGHAM DRIVE SUITE 226B
CARDIFF-BY-THE-SEA CA
92007-2408
US

V. Phone/Fax

Practice location:
  • Phone: 858-481-8810
  • Fax: 858-481-8816
Mailing address:
  • Phone: 858-481-8810
  • Fax: 858-481-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1634
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1672
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY14131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: