Provider Demographics
NPI:1144245515
Name:BRESLIN, SAGE DEBEIXEDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAGE
Middle Name:DEBEIXEDON
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:YVETTE
Other - Last Name:DEBEIXEDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:120 BIRMINGHAM DRIVE
Mailing Address - Street 2:SUITE 226B
Mailing Address - City:CARDIFF-BY-THE-SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2408
Mailing Address - Country:US
Mailing Address - Phone:858-481-8810
Mailing Address - Fax:858-481-8816
Practice Address - Street 1:120 BIRMINGHAM DRIVE
Practice Address - Street 2:SUITE 226B
Practice Address - City:CARDIFF-BY-THE-SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-2408
Practice Address - Country:US
Practice Address - Phone:858-481-8810
Practice Address - Fax:858-481-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1634103TC1900X
TN1672103TC1900X
CAPSY14131103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR96015Medicare UPIN
CACP14131AMedicare ID - Type UnspecifiedMEDICARE