Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS005236L | PA |
Y | 103TC0700X | Clinical Psychologist | PS005236L | PA |
NPI | 1003991456 |
---|---|
Provider Name | Dr. Anna Marie Breaux |
First Address | Wexford, PA 15090-9001 |
Second Address | Allison Park, PA 15101-1439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |