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General NPI Number Information
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NPI Number | 1932747367
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Entity Type | Individual
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Provider Name | TERESA LAU
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 506 VIA EL RISCO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6609
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Country | US
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Telephone | 949-296-7520
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 HUNTINGTON ST APT 1001
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-2862
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Country | US
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Telephone | 714-312-9126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 78806
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License Number State | CA
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