MEDICARE: CAROLYN BREAUD LMFT

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	106H00000X	Marriage & Family Therapist		CA
2	106H00000X	Marriage & Family Therapist	77137	CA
3	106H00000X	Marriage & Family Therapist	287	NH

General Provider Information

NPI Number	:	1194976795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN BREAUD LMFT

Provider Business Mailing Address
First Line	:	191 SAND CREEK RD
Second Line	:	SUITE 202-K
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD
Second Line	:	SUITE 202-K
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-759-0235
Fax Number	:

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	11/11/2022

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