MEDICARE: DR ANNA LAU PSYCHOLOGICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1750055042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ANNA LAU PSYCHOLOGICAL PC

Provider Business Mailing Address
First Line	:	1717 CAMDEN AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4907
Country	:	US
Telephone Number	:	626-239-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 CAMDEN AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4907
Country	:	US
Telephone Number	:	626-234-9500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNA LAU
Credential	:	PH.D.
Telephone Number	:	626-234-9500

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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