MEDICARE: DR. SAGE DEBEIXEDON BRESLIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	1634	GA
2	103TC1900X	Counseling Psychologist	1672	TN
3	103TC1900X	Counseling Psychologist	PSY14131	CA

General Provider Information

NPI Number	:	1144245515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAGE DEBEIXEDON BRESLIN PHD

Provider Business Mailing Address
First Line	:	120 BIRMINGHAM DRIVE
Second Line	:	SUITE 226B
City	:	CARDIFF-BY-THE-SEA
State	:	CA
Zip	:	92007-2408
Country	:	US
Telephone Number	:	858-481-8810
Fax Number	:	858-481-8816

Provider Business Practice Location Address
First Line	:	120 BIRMINGHAM DRIVE
Second Line	:	SUITE 226B
City	:	CARDIFF-BY-THE-SEA
State	:	CA
Zip	:	92007-2408
Country	:	US
Telephone Number	:	858-481-8810
Fax Number	:	858-481-8816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/28/2021

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