| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KRISTOFER JOONDEPH-BREIDBART | 1891290516 | 2022-10-01 |
Kristofer Joondeph-breidbart is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1891290516. Registration indicates Kristofer Joondeph-breidbart is a provider of access to mental health/behavioral health providers services with a specialization in Allopathic & Osteopathic Physicians, Psychiatry & Neurology (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Psychiatry & Neurology: Psychiatry, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychiatry & Neurology Psychiatry, Allopathic & Osteopathic Physicians) (Psychiatry & Neurology, ) Access to Mental Health/Behavioral Health Providers (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Psychiatry & Neurology: Psychiatry, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychiatry & Neurology Psychiatry, Allopathic & Osteopathic Physicians) (Psychiatry & Neurology, ) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) Access to Mental Health/Behavioral Health Providers (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Psychiatry & Neurology: Psychiatry, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychiatry & Neurology Psychiatry, Allopathic & Osteopathic Physicians) (Psychiatry & Neurology, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Dr. Kristofer Joondeph-breidbart MD |
| Other Provider Name | Dr. Kristofer Earles |
| Practice Office Address | 175 ELM ST SOMERVILLE, MA US |
| Practice Office Telephone | 6178047970 |
| Practice Office Fax | 6172036011 |
| Mailing Address | 32 MADISON ST # 2 SOMERVILLE, MA 021431209 US |
| Business Telephone | 6178047970 |
| Business Fax | 6172036011 |
| Code | Practice | License No State |
|---|---|---|
| 2084P0800X | Access to Mental Health/Behavioral Health Providers Allopathic & Osteopathic Physicians Psychiatry & Neurology Allopathic & Osteopathic Physicians Psychiatry & Neurology Psychiatry & Neurology: Psychiatry Behavioral Health/Substance Abuse/Psychiatry Psychiatry & Neurology Psychiatry Allopathic & Osteopathic Physicians Psychiatry & Neurology | 314147-01
NY |
| 2084P0800X | Access to Mental Health/Behavioral Health Providers Allopathic & Osteopathic Physicians Psychiatry & Neurology Allopathic & Osteopathic Physicians Psychiatry & Neurology Psychiatry & Neurology: Psychiatry Behavioral Health/Substance Abuse/Psychiatry Psychiatry & Neurology Psychiatry Allopathic & Osteopathic Physicians Psychiatry & Neurology | A177531
CA |
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | |
| 2084P0800X PRIMARY | Access to Mental Health/Behavioral Health Providers Allopathic & Osteopathic Physicians Psychiatry & Neurology Allopathic & Osteopathic Physicians Psychiatry & Neurology Psychiatry & Neurology: Psychiatry Behavioral Health/Substance Abuse/Psychiatry Psychiatry & Neurology Psychiatry Allopathic & Osteopathic Physicians Psychiatry & Neurology | 288089
MA |