MEDICARE: DR. NOAH MALUHIA LAU BRANSON PSYD

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	32992	CA

General Provider Information

NPI Number	:	1033878210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOAH MALUHIA LAU BRANSON PSYD

Provider Business Mailing Address
First Line	:	PO BOX 41153
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91114-8153
Country	:	US
Telephone Number	:	626-808-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S LAKE AVE STE 284D
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-5074
Country	:	US
Telephone Number	:	818-659-5903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	01/22/2022

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