MEDICARE: GAVIN JEREMY LAU MA

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	101YP2500X	Professional Counselor	PC019542	PA

General Provider Information

NPI Number	:	1063374502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN JEREMY LAU MA

Provider Business Mailing Address
First Line	:	710 CHESTNUT LN
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 CHESTNUT LN
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5124
Country	:	US
Telephone Number	:	484-845-3530
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ GAVIN JEREMY LAU MA” Practice Location

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