Provider Demographics
NPI:1588926661
Name:BREITMEYER, ANGELA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:BREITMEYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19389 N 59TH AVE
Mailing Address - Street 2:MIDWESTERN MULTISPECIALTY CLINIC -- CLINICAL PSYCHOLOGY
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6500
Mailing Address - Country:US
Mailing Address - Phone:623-537-6250
Mailing Address - Fax:623-537-6251
Practice Address - Street 1:19389 N 59TH AVE
Practice Address - Street 2:MIDWESTERN MULTISPECIALTY CLINIC -- CLINICAL PSYCHOLOGY
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6500
Practice Address - Country:US
Practice Address - Phone:623-537-6250
Practice Address - Fax:623-537-6251
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4280103T00000X
103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports