Provider Demographics
NPI:1033878210
Name:BRANSON, NOAH MALUHIA LAU (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:MALUHIA LAU
Last Name:BRANSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41153
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91114-8153
Mailing Address - Country:US
Mailing Address - Phone:626-808-6259
Mailing Address - Fax:
Practice Address - Street 1:350 S LAKE AVE STE 284D
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5074
Practice Address - Country:US
Practice Address - Phone:818-659-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical