Healthcare Provider Details

I. General information

NPI: 1043693120
Provider Name (Legal Business Name): LAUREN NICOLE LIU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 SAN PABLO AVE
EL CERRITO CA
94530-2157
US

IV. Provider business mailing address

11175 SAN PABLO AVE
EL CERRITO CA
94530-2157
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-3009
  • Fax:
Mailing address:
  • Phone: 510-559-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: