Mark D Breithaupt PHD Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY499 Issued in HI

Legal business name

MARK D BREITHAUPT PHD INC

Practice address

2200 Main St
Wailuku, HI 96793-1681

Phone

(808) 205-8403

NPI assigned

Oct 6, 2010

Last updated

May 19, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Douglas Breithaupt, PHDNPI 1053436337

Title

Licensed Clinical Psychologist

Phone

(808) 205-8403

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Douglas Breithaupt, PH.D.

  • Clinical Psychologist
  • Wailuku, HI
  • NPI 1053436337
  Medicare reassignment Authorized official
• Susan Frieder, PH.D.

  • Clinical Psychologist
  • Wailuku, HI
  • NPI 1548366636
  NPD (past)
• Charles Thomas Harding, PSY.D.

  • Counselor
  • Pearl City, HI
  • NPI 1558481184
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1902115082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2632",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967937632",
            "telephone_number": "808-205-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MAIN ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931681",
            "telephone_number": "808-205-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D BREITHAUPT PHD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "BREITHAUPT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-205-8403",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "HMSA",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03451701",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirley Eunice Mapson, MSW
• Marc S Emde MD Inc
• Jac Daniel Marden, MD
• Melia Maria, LMT
• Alexa Ah Lin Marino, LSW
• Mark D Breithaupt PHD LLC
• Mark E Haddad MD Inc
• Amanda Markell, PA-C
• Market Street Clinic, Inc.
• Amanda Marn, M.D.

• Clinical Psychologist in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Clinical Psychologist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.